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Nicholas Behunin, Ingrid U Scott, Zachary C Landis, Ana Rubin Panvini; Ocular Examination Findings and Orbital Fracture Locations Predictive of Ocular Injury in Patients with Orbital Fractures. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6055.
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Inpatient ophthalmology consultation is often obtained to rule out ocular injury in the setting of orbital fractures. We performed a retrospective chart review to investigate ocular examination findings predictive of ocular injury in patients with orbital fractures. We also investigated the correlation between orbital fracture location and ocular injury.
Medical records were reviewed of all patients who underwent inpatient ophthalmology consultation to rule out ocular injury in the setting of orbital fracture at Penn State Hershey Medical Center from July 31, 2011 to January 7, 2014. Patients with retinopathy of prematurity or non-accidental trauma were excluded. Data collected include demographics, mechanism of injury, fracture location, ocular examination findings, and ocular injury. Statistical analysis was performed with logistic regression utilizing Firth’s penalized likelihood approach.
The study included 203 patients (149 [73.4%] male; 54 [26.6%] female). The most common mechanism of injury was fall (78 total, 38.42%), followed by motor vehicle accident (44 total, 21.67%), and altercation/assault (22 total, 10.84%). Subconjunctival hemorrhage, chemosis, conjunctival injection, abnormal vision, abnormal pupils, and abnormal motility were each independently correlated with the presence of ocular injury (all p < 0.05). Interestingly, eyelid laceration and periorbital ecchymosis were not significantly correlated with ocular injury. Of the fracture patterns studied, only medial wall fracture was significantly associated with ocular injury (odds ratio [OR] 2.699; 95% confidence interval [CI] 1.257, 5.814; p=0.01). The presence of multiple orbital fractures did not significantly correlate with ocular injury. Orbital roof fracture was associated with an increased risk of optic neuropathy (OR 19.8; CI 1.875, 2679.356; p = 0.01).
In this study of patients with orbital fracture, subconjunctival hemorrhage, chemosis, conjunctival injection, abnormal vision, abnormal pupils, and abnormal motility were each independently correlated with ocular injury. Of the fracture patterns studied, only medial wall fracture was associated with ocular injury. The presence of multiple orbital fractures was not correlated with the presence of ocular injury.
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