Abstract
Purpose :
Orbital fracture and hyphema commonly present simultaneously as traumatic injuries. This requires practitioners to weigh the risk of exacerbating ocular injury in early fracture repair against potential suboptimal results if fracture repair is delayed. This study characterizes the longitudinal clinical outcomes of patients with comorbid hyphema and orbital fractures, addressing the existing gap in outcome data and the lack of consensus on optimal fracture repair timing.
Methods :
A retrospective chart review was conducted on 535 adult orbital fracture patients treated at a Level 1 emergency department from 2014-2017. Patients with prior orbital fracture, ocular injury, or ocular/orbital surgery were excluded. Demographic information, clinical exam details, and radiographic findings were recorded. Interim and final examination findings were obtained from follow-up visits within the same health system.
Results :
Of 535 orbital fracture patients, 34 presented with hyphema without concurrent open globe injury. A control group of 30 patients statistically similar in age and without hyphema was randomly selected from the same dataset. Mean follow-up time for both groups was 8 months. Patients with hyphema had worse visual acuity (VA in logMAR; 0.98 vs. 0.32 in controls; p=0.010) and higher intraocular pressure (IOP in mmHg; 19.9 vs. 14.6 in controls; p=0.002) at presentation. However, no significant differences were observed in final VA (0.57 vs. 0.22 in controls; p=0.069) or IOP (14.0 vs. 12.7 in controls; p=0.138). Hyphema patients suffered from a higher mean number of orbital walls fractured (2.29 vs. 1.67 in controls; p=0.037), with a higher likelihood of involvement of the medial wall (p=0.005). Approximately 50% of both hyphema patients and controls underwent fracture repair (p=0.625). Although patients with hyphema had a longer mean time until surgery (15 weeks vs. 2 weeks for controls), this difference was not significant (p=0.187). Subgroup analysis revealed no disparity in initial findings or final outcomes, including symptomatic diplopia, VA, or IOP.
Conclusions :
While patients with concomitant orbital fracture and hyphema initially presented with worse VA and IOP compared to those with orbital fracture alone, no significant differences were noted after 8 months. Increased clinical suspicion for comorbid hyphema is warranted in patients with fracture patterns involving the medial wall or two or more orbital wall fractures.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.