Purchase this article with an account.
Jared A Spitz, Elizabeth Chiang, Lily Saadat, Paul Bryar, Dustin French, Christopher B Chambers; Analysis of Decreased Vision with Facial Fractures. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5489.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
This study was an analysis of orbital, facial, and nasal fractures at Northwestern Memorial Hospital. The purpose was to evaluate the incidence of fracture location and associated symptoms.
The Enterprise Database Warehouse (EDW) was used to gather patient records from Northwestern Memorial Hospital (NMH) electronic medical records using ICD9 codes for facial fractures and CPT codes for orbital fracture repair between 2005 to 2012. The records of these patients were reviewed to determine location of fractures and evidence of decreased vision.
A total of 412 patients were identified with orbital fractures. Of these, 105 (25.5%) had isolated fractures, 270 (65.5%) had multiple fractures of a single orbital, and 37 (9.0%) had bilateral orbital fractures. Of the patients with single wall fractures, 75 (70.8%) had floor fractures, 21 (19.8%) had medial wall fractures, 6 (5.7%) had roof fractures, and 3 (2.8%) had lateral wall fractures. Of those patients with bilateral orbital fractures, 15 (40.5%) had additional facial fractures, excluding nasal fractures; 1 (2.7%) had a nasal fracture in addition to the orbital fractures; and 20 (54.1%) had both nasal fractures and other non-nasal facial fractures. Of the 376 patients with single orbit fractures, 141 (37.5%) had additional non-nasal facial fractures, 24 (6.4%) had an additional nasal fracture, and 69 (18.3%) had both nasal and other facial fractures. For patients with non-nasal facial fractures, 235 (96.3%) were associated with multiple orbital fractures with the remaining 9 fractures were associated with an isolated fracture. Of those with nasal fractures, all 114 were associated with multiple orbital fractures. Of the 412 patients with orbital fractures, only 51 (12.4%) had documented decreased vision on exam: 4 (0.9%) had nasal fractures in addition to their orbital fracture, 10 (2.4%) had non-nasal facial fractures, and 13 (3.2%) had both types of fractures. 40 (9.7%) patients had complaints of vision loss without documentation on exam: 2 (5.0%) had nasal fractures, 18 (45.0%) had non-nasal facial fractures, and 9 (22.5%) had both types of fractures.
Most patients had multiple fractures within a single orbit with a small minority having bilateral fractures. Despite the low frequency, bilateral fractures were strongly associated with other facial fractures. While decreased vision was not found in most patients, it was associated with extra-orbital fractures.
This PDF is available to Subscribers Only