March 2012
Volume 53, Issue 14
Free
ARVO Annual Meeting Abstract  |   March 2012
Pediatric Orbital Fractures Presenting to a Level 1 Trauma Center: A Review of 83 Consecutive Cases
Author Affiliations & Notes
  • Julia Nemiroff
    Department of Ophthalmology, NYU Langone Medical Center, New York, New York
  • Elana Rosenberg
    Department of Ophthalmology, NYU Langone Medical Center, New York, New York
  • Samuel Baharestani
    Department of Ophthalmology, NYU Langone Medical Center, New York, New York
  • Footnotes
    Commercial Relationships  Julia Nemiroff, None; Elana Rosenberg, None; Samuel Baharestani, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 4963. doi:
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      Julia Nemiroff, Elana Rosenberg, Samuel Baharestani; Pediatric Orbital Fractures Presenting to a Level 1 Trauma Center: A Review of 83 Consecutive Cases. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4963.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose:
 

To investigate epidemiologic factors, co-morbidities, and the interdisciplinary approach to the evaluation and management of acute orbital fractures (AOF) in the pediatric age group that present to a Level I trauma center of a New York City public hospital.

 
Methods:
 

We conducted a retrospective review of 83 cases of acute fractures of the orbital wall(s) occurring in patients 25 years of age or younger that presented to the Bellevue Hospital Pediatric Emergency Room from July 2007 to October 2011. Medical records were screened for demographic features, associated history, ocular/systemic co-morbidities, and radiographic findings. An IRB exemption was obtained from the Bellevue Research Committee.

 
Results:
 

Mean age in the study cohort was 20.2 years (Range: 1 - 25 years) with 21.7% 18 years old or younger and 85.5% males. 60.2% from assault, 8.4% from motor vehicle accidents, 8.4% from pedestrian accidents, 8.4% from falls, 8.4% from sports related injuries, 4.8% from nonspecific blunt trauma, and 1.2% from gunshot wounds. Via radiographic review, fractures of only the orbital floor comprised 45.8% of cases, only the medial wall was 21.7%, only the orbital roof was 8.4%, only the lateral wall was 3.6%, while fractures involving multiple walls comprised 20.5% of cases. Of those cases with multiple orbital wall fractures, the majority were associated floor and medial wall fractures, comprising 7.2% of total cases. 42.2% of cases demonstrated restriction of extraocular muscles (EOM). All patients were communicative and able to cooperate with an ophthalmologic exam. However, only 12.0% reported subjective diplopia and only 10.8% of total cases showed radiographic evidence of muscle entrapment. 53% of patients exhibited subconjunctival hemorrhage. Retrobulbar hemorrhages were seen in 8.4% of cases [n=7/83]. 6.0% of cases [n=5/83] exhibited commotio retinae, while 2.4% [n=2/83] exhibited vitreous hemorrhage. Finally, 21.7% of patients suffered an additional facial fracture associated with the orbital fracture. There were no documented retinal detachments in this review. Because of inter-observer variability in data tabulation, cosmetically-unacceptable enophthalmos and fracture size were not recorded although both represent well-described reasons for emergent repair.

 
Conclusions:
 

Males with fractures of the orbital floor via assault are most representative of cases of AOF in the pediatric age group. Our patients more often exhibit restriction of EOMs rather than radiographic evidence showing muscle entrapment, with diplopia only occasionally being present.

 
Keywords: trauma • orbit • imaging/image analysis: clinical 
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