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John Fileta, Ingrid U Scott; Frequency of Ocular Injury, and Examination Findings Predictive of Serious Ocular Injury, in Patients with Orbital Fractures.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5491.
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To investigate the frequency of ocular injury and examination findings predictive of serious ocular injury in patients with orbital fractures.
Medical records were reviewed of patients evaluated at Penn State Hershey Medical Center between August 1 - December 31, 2012 with orbital fracture (confirmed by CT) and had a complete ophthalmologic examination within 24 hours of injury. Fisher exact test analysis was used for statistical analysis.
The study included 48 patients with a mean age of 42 years. 35 of the patients (73%) were men. The most common causes of orbital fracture injuries were falls (33%), motor vehicle accident (31%), and assault (23%). At presentation, 28 patients (58%) were visually asymptomatic, 11 (23%) were intubated/sedated/unable to respond, and 9 (19%) had visual complaints (blurry vision, loss of vision, floaters, or double vision). Snellen visual acuity (VA) on initial presentation was 20/20 in 11 patients (23%), 20/25-20/40 in 16 patients (33%), 20/50 or worse in 7 patients (15%), and unobtainable in 14 patients (29%). The most common ocular injuries associated with fractures were eyelid edema/ecchymosis (79.2%), subconjunctival hemorrhage (46%), eyelid laceration (17%), and corneal abrasion (10%). Uncommon associated ocular injuries include traumatic optic neuropathy (4%), ruptured globe (4%), commotio retinae (2%), and hyphema (2%). VA at last follow-up was 20/25 or better in 37 patients (77%) and worse than 20/25 in 5 patients (10%); 6 patients (13%) did not have follow-up VA data secondary to being lost to follow-up. Serious ocular injury was sustained in 4 patients (8%) with orbital fractures (2 ruptured globes, 1 traumatic optic neuropathy, and 1 cranial nerve 3 palsy). There were no serious ocular injuries in asymptomatic patients; and none of the asymptomatic patients required urgent ophthalmologic intervention (p=.004). None of the patients with an orbital fracture and a VA of 20/40 or better required prompt ophthalmologic intervention (p=0.028).
Serious ocular injury was present in 8% of patients with orbital fractures, and was present only in incapacitated patients, patients with visual complaints and VA of 20/50 or worse at presentation or with extensive ocular damage visible on external examination. Serial follow-up examinations reveal that the vast majority of patients return to their baseline VA.
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