Abstract
Purpose :
There are variable reports in the literature of concomitant retinal pathology in patients with orbital fractures. We performed a retrospective cohort study to identify the prevalence of retinal pathology among any ocular injuries sustainted in these patients.
Methods :
This retrospective chart review included patients with orbital fractures seen by ophthalmology from 2016- 2018 at a Level I trauma center. Our primary outcome was the incidence of traumatic retinal pathology in patients at initial dilated exam and subsequent follow-up visits. Secondary outcomes were the rates of follow-up examinations, and the associations between retinal injuries and orbital fracture location and mechanism of injury.
Results :
A total of 241 patients and 275 eyes (mean age of 50, 72% male and 28% female) were included. The rate of dilated fundus examination at initial trauma visit was 84% (230 eyes) and increased to 92% (253 eyes) overall after follow-up. The rate of follow-up with ophthalmology was 60% and 84% between all specialties. The median time to ophthalmology follow-up after initial visit was 2 weeks (SD 9.45). The most common mechanisms were assault (32%) and fall from own height (25%). Excluding the 2 globe ruptures, the total incidence of retinal pathology was 5.2% (12), including 2.6% (6) with commotio retinae, 1.3% (3) with vitreous hemorrhage including 1 Terson’s syndrome, and 1.3% (3) with retinal hemorrhage. There were no occurrences of a retinal tear nor a retinal detachment, and the incidence of retinal pathology was stable at follow-up. 25% (68) of fractures involved the orbital roof, 70% (193) the orbital floor, 45% (125) the lateral wall, and 45% (125) the medial wall. Medial wall fractures were associated with retinal pathology (OR 3.80, CI 1.01- 14.36, p= 0.048) along with work- related injuries (OR 15.93, CI 3.96-64.07, p=0.000096). Other documented injuries included globe rupture (2,0.007%) and traumatic optic neuropathy (2, 0.008%).
Conclusions :
Factors related to retinal pathology were medial-wall fractures and work-related mechanisms of injury. In accordance with the literature, the risks of retinal tears and retinal detachments are low. However, given the prevalence of vitreous and retinal hemorrhages, the potential risk for rhegmatogenous sequelae remains, supporting the need for dilated fundus examinations in patients with orbital fractures.
This is a 2020 ARVO Annual Meeting abstract.