April 2014
Volume 55, Issue 13
ARVO Annual Meeting Abstract  |   April 2014
Frequency of Ocular Injury, and Examination Findings Predictive of Serious Ocular Injury, in Patients with Orbital Fractures.
Author Affiliations & Notes
  • John Fileta
    Penn State Hershey Eye Center, Hershey, PA
  • Ingrid U Scott
    Penn State Hershey Eye Center, Hershey, PA
  • Footnotes
    Commercial Relationships John Fileta, None; Ingrid Scott, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 5491. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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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  

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