June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Ophthalmic manifestations of superior orbital blow-in fractures with and without bone fragment globe compression
Author Affiliations & Notes
  • Carl Rebhun
    Ophthalmology, NYU Langone Health, New York, New York, United States
  • Katharine Dempsey
    Ophthalmology, NYU Langone Health, New York, New York, United States
  • Ann Tran
    Ophthalmology, NYU Langone Health, New York, New York, United States
    Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, Northwell Hospital, New York, New York, United States
  • Andrea Tooley
    Ophthalmology, NYU Langone Health, New York, New York, United States
    Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, Northwell Hospital, New York, New York, United States
  • Irina Belinsky
    Ophthalmology, NYU Langone Health, New York, New York, United States
  • Eleanore Kim
    Ophthalmology, NYU Langone Health, New York, New York, United States
  • Kyle J. Godfrey
    Ophthalmology, Weill Cornell Medical College, New York, New York, United States
  • Footnotes
    Commercial Relationships   Carl Rebhun, None; Katharine Dempsey, None; Ann Tran, None; Andrea Tooley, None; Irina Belinsky, None; Eleanore Kim, None; Kyle Godfrey, None
  • Footnotes
    Support  Supported in part by an unrestricted grant from Research to Prevent Blindness to NYU Langone Health Department of Ophthalmology
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 2932. doi:
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    • Get Citation

      Carl Rebhun, Katharine Dempsey, Ann Tran, Andrea Tooley, Irina Belinsky, Eleanore Kim, Kyle J. Godfrey; Ophthalmic manifestations of superior orbital blow-in fractures with and without bone fragment globe compression. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2932.

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

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Abstract

Purpose : To describe clinical features requiring urgent surgical intervention for superior orbital blow-in fractures with and without globe compression.

Methods : Retrospective, consecutive case series between 6/1/2018 and 12/1/2019.

Results : Six patients (6 eyes) with superior orbital blow-in fractures were identified, 50% with bone fragments compressing the globe. The mean age of presentation was 31.8 ± 10.5 years. The majority of patients were male (83%), involved the left eye (83%), and were assault victims with a swinging object (50%). All patients had periorbital edema and a brow laceration. No patients had clinical evidence of a ruptured globe. The visual acuity of the affected eye ranged from 20/20 to 20/30. Post-operative visual acuity worsened in one case (16%) due to vitreous hemorrhage. Surgical approaches included lateral orbitotomy through the brow laceration (66%), through an eyelid crease incision (17%) and a craniotomy (17%).

The most common fracture types on computed tomography included communicated fractures of the frontal sinus to the superior orbital rim (83%), involvement of the zygomatic bone (33%) and an inferiorly displaced superior orbital rim (17%). Additional orbital injuries included left rectus hematoma (16%), bone fragment abutting the lacrimal gland (50%) and intraconal hematoma (33%). An intracranial injury was seen in 33% of patients, including a parieto-occipital hematoma and frontal white matter contusion.

Fifty percent of patients had bone fragments directly compressing the globe with deformation of the globe contour, which was visible on fundoscopic examination and bedside ocular ultrasound. Distinguishing features of orbital blow-in fractures with globe compression compared to those without included supra- and abduction motility deficits, proptosis, globe dystopia and abnormal posterior segment exam, which were seen in all cases. Posterior segment findings included choroidal folds (100%), choroidal rupture (33%), commotio (33%) and vitreous hemorrhage (33%), however there were no retinal tears or detachments.

Conclusions : In cases of periocular trauma, the presence of exophthalmos, globe dystopia, ocular motility deficits, and choroidal folds may suggest an orbital blow in fracture with globe compression. These findings should prompt expedited imaging and surgical intervention when appropriate.

This is a 2020 ARVO Annual Meeting abstract.

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