Prospective Analysis of Ocular Injuries Associated with Orbital Fractures

Abstract

Abstract: : Purpose: Ophthalmologists frequently are asked to evaluate the globe in the setting of blunt orbital trauma with a resulting orbital fracture. The incidence of ocular injuries associated with orbital fractures has never been examined in a prospective fashion. To determine the incidence of ocular injuries associated with orbital fractures we prospectively examined patients with documented orbital fractures using a standardized ocular and orthoptic evaluation. Methods: All adult patients presenting within 3 days of their injury with a documented orbital floor fracture by CT scan and were able to give informed consent were offered enrolment. Twenty-seven patients were recruited over 2.5 years under an approved IRB protocol. Each patient then underwent a complete standardized ocular examination as well as a full orthoptic evaluation to systematically delineate the nature of their symptoms and extent of their ocular injuries. Results: The two most common ocular symptoms reported were blurred vision (15 patients, 56%) and double vision (13 patients, 48%). Twelve patients (44%) had numbness in the distribution of the infraorbital nerve. The majority of patients had abnormalities of the anterior segment (22 patients, 81%), while 9 patients (33%) had abnormalities of the posterior pole. Chemosis and subconjunctival hemorrhage were the most common anterior segment injuries; 3 patients had traumatic iritis, 3 patients had hyphemas, and one patient had an iris sphincter tear. Eight of the 9 patients with posterior pole pathology had commotio, 1 patient had a vitreous hemorrhage and another with a macular hole. Of the 4 patients with best-corrected visual acuity worse than 20/40, 2 patients had macular commotio, 1 had a hyphema, and 1 had a macular hole. While 13 patients (48%) complained of diplopia (see above), 16 (59%) patients had diplopia within 20 degrees of fixation when tested objectively. The large majority of patients had either proptosis (10 patients, 37 %) or no difference when compared to the contralateral side (15 patients, 55%); only two patients had acute enophthalmos. Conclusions: The true incidence of ocular injuries associated with orbital fractures is significant. Several patients had vision threatening injuries, and the majority of patients had diplopia within 20 degrees of fixation. Our results support the assertion that all patients with an orbital fracture should have a complete ophthalmic evaluation, especially if best-corrected visual acuity is reduced, or surgical correction of the fracture is planned.

Keywords: trauma • orbit • clinical (human) or epidemiologic studies: pre