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Han-Ying P. Chang, Nancy Huynh, Sheila Borboli-Gerogiannis; Eye Injuries Associated With Orbital Or Periorbital Trauma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4962.
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To investigate and categorize types and frequencies of eye injuries associated with orbital or periorbital trauma.
A retrospective review was conducted on all patients who presented to the Brigham and Women’s Hospital with orbital or periorbital trauma for which an ophthalmological consult was requested between July 2009 and February 2011.
Of the 850 total consult requests seen by the Ophthalmology service during the 20-month time period, 189 were for ophthalmological evaluation after orbital or periorbital trauma. Major causes of trauma were the following: fall (43%), motor vehicle accident (24%), and assault (16%). Other causes included various blunt objects (i.e., softball, golf ball, elbow, knee) to the periorbital region, gunshot wounds, and fireworks to the face. 36% of patients were noted to have varying degrees of intracranial injury, the most common of which were small subarachnoid or subdural hemorrhages. 51 (27%) patients had a single orbital wall fracture, and 93 (49%) patients had multiple orbital wall fractures. Amongst the patients with orbital wall fractures, there were no cases of extraocular muscle entrapment requiring emergent surgical intervention, though 41 (28%) patients did ultimately undergo fracture repair. Additionally, 11 (5.8%) patients were noted on imaging to have a retrobulbar hematoma; 3 of these were clinically found to have compartment syndrome requiring emergent canthotomy and cantholysis, and 1 had associated rise in intraocular pressure managed medically. On ophthalmological examination, findings included 31 (16%) normal eye exams; 81 (43%) with nothing more than periorbital ecchymosis and/or subconjunctival hemorrhage; 33 (17%) eyebrow or lid lacerations, including 3 cases involving the lid margins and 1 case involving a canaliculus; 7 (3.7%) corneal abrasions; 8 (4.2%) hyphema or microhyphema; 7 (3.7%) traumatic iritis and/or mydriasis; 15 (7.9%) commotio retinae; 5 (2.6%) vitreous and/or retinal hemorrhages; 1 large retinal detachment; 5 (2.6%) traumatic optic neuropathy; 6 (3.2%) associated cranial nerve III, IV, or VI injuries; 8 (4.2%) ruptured globe injuries (including 1 occult posterior globe injury initially obscured by dense vitreous hemorrhage).
Orbital or periorbital trauma is often associated with significant eye injuries, and the ophthalmologist’s role is important in diagnosing and initiating appropriate treatment for these injuries.
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