July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Orbital Fractures and Final Visual Acuity in Operation Iraqi Freedom and Operation Enduring Freedom: 2001-2011
Author Affiliations & Notes
  • Grant Justin
    Ophthalmology, Brooke Army Medical Center, San Antonio, Texas, United States
  • Brett Davies
    Ophthalmology, Brooke Army Medical Center, San Antonio, Texas, United States
  • Daniel Brooks
    Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Denise Ryan
    Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Eric Weichel
    Retina Group of Washington, Maryland, United States
  • Marcus Colyer
    Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Footnotes
    Commercial Relationships   Grant Justin, None; Brett Davies, None; Daniel Brooks, None; Denise Ryan, None; Eric Weichel, None; Marcus Colyer, None
  • Footnotes
    Support  Office of the Assistant Secretary of Defense for Health Affairs under the Broad Agency Announcement for Extramural Medical Research, BAA-16-R-BAA1 under Award No. W81XWH-17-2-0007.
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 2511. doi:
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      Grant Justin, Brett Davies, Daniel Brooks, Denise Ryan, Eric Weichel, Marcus Colyer; Orbital Fractures and Final Visual Acuity in Operation Iraqi Freedom and Operation Enduring Freedom: 2001-2011. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2511.

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

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Abstract

Purpose : Present an update to the incidence of orbital fractures and the effect on final visual acuity in soldiers admitted to Walter Reed Army Medical Center (WRAMC) from 2001-2011 after sustaining combat injuries in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF).

Methods : Data was collected in the Walter Reed Ocular Trauma Database. Inclusion criteria were any American Soldier or Department of Defense (DoD) civilian with an orbital fracture injured in OIF and OEF. Primary outcome measures were final visual outcome, and the anatomical location and number of walls fractured.

Results : 890 eye injuries occurred in 652 patients evacuated to WRAMC between 2001 and 2011. Orbital fractures occurred in 304 eyes (34.2%). A single wall was fractured in 140 eyes (46.1%), two in 99 (32.6%), three in 31 (10.2%), four in 28 (9.2%) and unknown in 6 (1.9%) eyes. Roof fractures were found in 74 (24.3%) eyes, medial wall in 135 (44.4%), lateral wall in 109 (35.9%) and floor fractures in 217 (71.4%). Final visual acuity was analyzed and 140 (46.1%) eyes had greater than 20/40 vision, 17 (5.6%) 20/40 to 20/200, 26 (8.5%) count fingers to light perception, 95 (31.3%) no light perception and 26 (8.5%) unknown. In regression analysis, roof (p=0.001), medial (p=0.009) and lateral fractures (p=0.016) were significantly associated with final visual acuity less than 20/200, while floor fractures were not (p=0.9). Regression analysis found that neither the number of walls fracture (p=0.1) or roof fracture p=0.1) were independent risk factors for final visual acuity less than 20/200 when associated injuries such as retinal detachment, phthisis, globe rupture or perforation, and optic nerve injury were included in the model (all p<0.001). Orbital fracture, all fracture subtypes and an increasing number of wall fractures were significantly associated with traumatic brain injury, retrobulbar hematoma, optic nerve injury, but not for vitreous hemorrhage, commotio retinae, hyphema, and choroidal rupture. Fracture repair was noted in 45 (14.8%).

Conclusions : Orbital fractures were a very common ocular injury in OIF and OEF, and approximately 40% of these patients remained legally blind.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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