Abstract
Purpose :
Evaluation of orbital trauma is a common reason for ophthalmology consultation at urban institutions in the Bronx. Our goal was to assess the mechanism/intention and degree of injury and their relation to development of commotio retinae.
Methods :
This retrospective study evaluated patients who suffered trauma resulting in orbital fractures, confirmed by CT scans. All patients were seen in the emergency department from July 2017 to September 2019, across 6 hospitals, one of which is a Level 1 trauma center. Demographics and circumstances of injury, ophthalmic examination and CT scan findings were tabulated. Central (Berlin’s edema) and peripheral commotio were combined prior to analysis. Statistical analysis used two-tailed student's-t, chi-squared and odds ratio calculations on STATA 14.2 software. Statistical significance was set at p<0.05.
Results :
204 patients with orbital fractures were included in this study. The mean age was 42.1±20.1 years and they were predominantly male (75.5%). Orbital fractures involving one wall (58.8%) were more common that those affecting more than one wall (41.2%). Most fractures affected the orbital floor/inferior wall (60.3%) and the medial wall (19.6%). Common mechanisms were documented as assault (59.3%), falls (24%) and motor vehicle accidents (8.3%). Assault was the most likely mechanism in males (OR=1.8, p=0.061) and patients in the 21-64yrs age group (OR=5.0, p<0.001), while falls prevailed in females (OR=3.7, p=0.001) and patients over 65yrs old (OR=9.7, p<0.001). There was no stronger relation of one mechanism over another with respect to extent of orbital injury, however falls were most associated with roof fractures (OR=3.7, p<0.004), and sports-related injuries with zygomatico-maxillary complex fractures (OR=5.3, p=0.033). Common associated ocular findings were subconjunctival hemorrhage (51.4%) and commotio retinae (20%). Assault was significantly associated with commotio (OR=5.2, p=0.001) and falls had the lowest odds of commotio (OR=0.1, p=0.003). More extensive orbital fractures were not associated with a higher chance of commotio.
Conclusions :
In this population, assault was the most common cause of orbital fractures and resulted in commotio retinae more than other mechanisms and extent of orbital injury. Ophthalmologists should have a high index of suspicion for commotio in patients with orbital fractures resulting from assault.
This is a 2020 ARVO Annual Meeting abstract.