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Margaret E Phillips, Margaret L Pfeiffer, Karina Richani, Helen A Merritt; Predicting severe ocular trauma in orbital wall fractures. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5958.
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© ARVO (1962-2015); The Authors (2016-present)
To define the incidence of severe ocular trauma in orbital fracture patients and determine if ocular signs and symptoms are useful as predictors of severe ocular trauma.
A retrospective chart review was conducted on all patients with orbital fractures between April 2013 and December 2014. Patients were included if they had radiographic evidence of acute fracture of at least 1 orbital wall and were seen by Ophthalmology during admission. Patients were excluded for incomplete records or if unable to cooperate during the exam. We collected demographics, concurrent injury data, and symptoms (blurred vision, diplopia, pain with eye movements, photophobia, flashes or floaters) and signs (visual acuity and extraocular movements) of ocular trauma.Concurrent ocular injuries were grouped by severity (severe, moderate, or mild). Severe injuries required urgent Ophthalmology consult such as open globe, muscle entrapment, and hyphema. Moderate injuries included corneal abrasion and eyelid laceration. A mild injury was a subconjunctival hemorrhage.Predictive signs or symptoms for severe ocular trauma were identified by stepwise logistic regression analysis. The threshold point for number of predictive signs and symptoms were determined by a receiver operating characteristic (ROC).
512 patients met the eligibility criteria with mean age of 44 years (± 19.8, range: 8 - 94 years). A majority (74%) of the patients were male. The most common mechanisms of injury were assault (39%), fall (25%), and motor vehicle accident (21%). 94.5% of patients were evaluated by ophthalmology within 1 day of injury. The incidence of any concurrent ocular trauma was 74.8% (383/512) with 13.7% (70/512) being severe.Of the 7 signs and symptoms studied, 4 were predictors of severity: blurred vision (P<0.001), pain with eye movements (P=0.008), visual acuity worse than 20/40 in the ipsilateral eye (P<0.001), and restricted motility (P=0.001). The presence of 2 or more of these signs or symptoms was predictive of severe ocular trauma with high sensitivity (87.3%) and specificity (80.3%).
In cooperative patients with acute orbital wall fractures, the presence of 2 or more signs or symptoms is predictive of severe ocular trauma and necessitates the need for emergent ophthalmic consultation.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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