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Joseph Santamaria, Aditya Mehta, Donovan Reed, Bradley Bishop, Brett Davies; Orbital roof fractures as an indicator for concomitant ocular injury. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2300.
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© ARVO (1962-2015); The Authors (2016-present)
Orbital roof fractures are a significant cause of morbidity in trauma and are associated with a spectrum of orbital and ocular injuries. We performed a retrospective analysis in order to characterize orbital roof fracture patterns and quantify the rate of acute intervention as compared to non-roof involving orbital wall fractures.
This study is a retrospective analysis of 340 orbital wall fractures diagnosed by CT imaging from August 2015 to October 2016 at San Antonio Military Medical Center. Orbital wall fractures were categorized as roof involving (N=50) and non-roof involving (N=290). Comparisons were made between these two groups using Pearson’s χ2 test or Fisher’s exact test to indicate a statistically significant difference in mechanism of injury, subjective symptoms, CT and exam findings, and final plan of care to include acute ophthalmologic intervention at the time of consultation.
Assault (40.7%) was the most common cause of non-roof involving fractures (p=0.025) while falls from height (20.0%) were associated with a higher rate of roof fractures (p=<0.001). Roof involving orbital wall fractures were associated with a higher prevalence of corneal abrasions (16.3%, p=0.004), lid lacerations (23.4%, p=0.031), and traumatic optic neuropathy (10.4%, p=0.003). A reliable subjective exam on initial ophthalmic consultation was not achieved (e.g. due to patient GCS) in a larger proportion of roof fracture patients (30%, p<0.001). Despite this, the rate of acute intervention in this group (34%) was almost double, including lateral canthotomy and cantholysis (p<0.001).
Concomitant ocular injury is common in roof involving orbital wall fractures, and may require more urgent ophthalmologic evaluation and acute intervention. As subjective patient data is often less readily available, a high index of suspicion and thorough investigation is warranted in caring for patients with roof involving orbital wall fractures.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Table 1: Characteristics of the study patients with orbital wall fractures
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