Global Current Practice Patterns for the Management of Traumatic Optic Neuropathy and Orbital Floor Fractures

Abstract

Purpose : Facial trauma can have a variety of sequelae, including orbital floor fractures and traumatic optic neuropathy. Although these injuries are common, their management is controversial. Our goal was to summarize management practices at international high-volume eye trauma centers and identify areas of alignment and discrepancy.

Methods : An online survey was conducted from August 2020 to January 2021 to obtain a
census of management paradigms for orbital floor fractures and traumatic optic neuropathy at high-volume eye trauma centers globally. Trauma experts responded on behalf of general practices at their institutions.

Results : Response rate was 85.7% (36/42); 3 of the responding centers were excluded from analysis due to low case volume. Of the responding institutions, 54.5% (n=18/33) routinely administered systemic antibiotics for orbital floor fractures, with oral amoxicillin and clavulanic acid (n=13/18, 72.2%) and oral cefalexin (n=4/18, 22.2%) being most common. Only 27.3% (n=9/33) of respondents administered systemic steroids, most of whom utilized oral steroids (n=7/9, 77.8%). Respondents considered the optimal timing for surgical repair of orbital floor fractures to be on average 11.46 ± 8.46 days from presentation, with oculoplastic surgeons participating in performing the repair at 72.7% (n=24/33) of responding institutions and oral and maxillofacial surgeons at 57.6% (n=19/33) of centers. Most experts did not routinely admit patients with isolated orbital fractures on presentation (n=26/33, 78.8%); however, 48.5% (n=16/33) of respondents admitted patients after the repair for an average of 3.50 ± 1.96 days. For cases of traumatic optic neuropathy, 63.6% (n=21/33) of respondents routinely administered systemic steroids, with 57.1% (n=12/21) preferring intravenous administration. High dose steroids (methylprednisolone 1gm daily) were used by 36.4% (n=12/33) of responding centers and moderate doses (prednisone 1 mg/kg daily) were preferred by 21.2% (n=7/33).

Conclusions : While experts largely agreed on administering antibiotics for orbital floor fractures and steroids for traumatic optic neuropathy, responding trauma experts differed on many aspects of optimal management paradigms. Further investigations are needed into best treatment regimens to institute evidence-based care in ophthalmic trauma.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.