Abstract
Purpose:
To investigate the frequency of ocular injury and examination findings predictive of serious ocular injury in patients with orbital fractures.
Methods:
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.
Results:
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).
Conclusions:
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.
Keywords: 742 trauma •
462 clinical (human) or epidemiologic studies: outcomes/complications •
464 clinical (human) or epidemiologic studies: risk factor assessment