Purchase this article with an account.
Catherine He, Matthew Wieder, Malack Hamade, Afshin Parsikia, JOYCE MBEKEANI; Ocular and Head Injuries Associated with Orbital Fractures. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2528.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Orbital injuries often extend beyond visual impairment to include surrounding structures, mandating multi-disciplinary management. We aim to identify the types of orbital fractures and their associated head and other eye injuries in major trauma patients.
A retrospective evaluation of the National Trauma Data Bank (2008-2014) was conducted and patients with different orbital injuries and wall fractures were identified using ICD9 codes. Statistical analysis of tabulated data was performed with SPSS software. Categorical and continuous variables were correlated using student t-test, chi-squared and odds ratios (OR) were calculated. Statistical significance was set at p<.05.
Orbital fractures were the leading type of ocular trauma, accounting for 124,887 (39.5%) out of 316,485 cases. 72.1% were male. 64.8% had associated traumatic brain injury (TBI) and head injuries included cranial vault fracture (11%), subarachnoid hemorrhage (10.6%), subdural hemorrhage (9.2%) and skull base fractures (7.1%). The most common orbital fractures were closed orbital floor (95.8%), roof without intracranial (I/C) injury (10.1%) and open floor fractures (4.1%). Other closed fractures (including lateral and medial walls) made up 31.5%. Closed orbital floor fractures had the greatest likelihood of mild injury severity score (ISS) (OR=2.11; CI 1.95-2.27) and mild TBI (OR=2.78; CI 2.62-2.95); p<0.001. Although roof fractures with I/C injury accounted for only 0.07% of all orbital fractures, they had the greatest likelihood of retinal edema (OR=4.11; CI 2.12-7.95), visual pathway (OR=10.59; CI 5.3-21.19) and open eyeball injuries (OR=7.87; CI 4.71-13.13), severe TBI (OR=3.35; CI 2.07-5.41) and very severe ISS (OR=6.91; CI 4.49-10.63); p<0.001. Self-inflicted orbital injuries were most often the result of firearms (OR=5.59; CI 5.08-6.15), had the greatest odds of association with roof and I/C injury (OR=40.97 CI 27.73-65.23) and carried the greatest risk of severe TBI (OR=8.15; CI 7.38-9.00), severe ISS (OR=5.48; CI 4.98-6.03), and mortality (OR=7.6; CI 6.77-8.53); p<0.001.
We found a variance in the impact of different types of orbital wall fractures. Closed orbital floor fractures were the most common and benign. Roof fractures with I/C injury, although rare, were most associated with visually threatening injuries, most severe levels of TBI and ISS and mortality.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
This PDF is available to Subscribers Only