Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov/Dec;35(6):609-614.
doi: 10.1097/IOP.0000000000001422.

Screening Criteria for Detecting Severe Ocular Injuries in the Setting of Orbital Fractures

Karina Richani  1   2   3 , Thai H Do  1   2   3 , Helen A Merritt  1   2   3 , Margaret L Pfeiffer  1   2   3 , Alice Z Chuang  1   2   3 , Margaret E Phillips  1   2   3
Affiliations

Screening Criteria for Detecting Severe Ocular Injuries in the Setting of Orbital Fractures

Karina Richani et al. Ophthalmic Plast Reconstr Surg. 2019 Nov/Dec.

Abstract

Purpose: Define incidence of severe ocular trauma in orbital fracture patients and determine if ocular signs and symptoms are useful predictors of severe ocular injuries.

Methods: Retrospective chart review was performed on all patients with orbital fractures between April 1, 2013, and December 31, 2014. Patients were included if they had radiographic evidence of acute fracture of at least one orbital wall and were evaluated by the Ophthalmology service. Demographics, concurrent injury data, and symptoms and signs of ocular trauma were collected. Concurrent ocular injuries were grouped by severity. Predictive signs or symptoms for severe ocular trauma were identified by stepwise logistic regression analysis. The threshold point for predictive signs and symptoms was detected by a receiver operating characteristic (ROC).

Results: Five-hundred-twelve patients were included. The most common mechanisms of injury were assault (39%), fall (25%), and motor vehicle accident (21%). The incidence of any concurrent ocular trauma was 75% (383/512), with 14% (70/512) being severe. Four signs and symptoms were predictors of severity: blurred vision (P < 0.0001), pain with eye movements (P < 0.0001), visual acuity worse than 20/40 in the ipsilateral eye (P < 0.001), and restricted motility (P < 0.001). The presence of 2 or more of these signs or symptoms was predictive of severe ocular trauma with high sensitivity (91%) and specificity (86%).

Conclusions: In cooperative patients with acute orbital wall fractures, the presence of 2 or more signs or symptoms is predictive of severe ocular trauma and necessitates the need for urgent ophthalmic consultation.Severe ocular injury associated with orbital wall fracture is more likely in patients with 2 or more ophthalmic signs or symptoms.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Receiver Operating Characteristic Curve (ROC) demonstrating the number of predictive signs and symptoms that were able to discriminate severe and non-severe injury with AUROC=0.87.
See this image and copyright information in PMC

References

    1. Cook T Ocular and periocular injuries from orbital fractures. J Am Coll Surg 2002;195:831–4. - PubMed
    1. Holt GR and Holt JE Incidence of eye injuries in facial fractures: an analysis of 727 cases. Otolaryngol Head Neck Surg 1983;91:276–9. - PubMed
    1. Kreidl KO, Kim DY and Mansour SE Prevalence of significant intraocular sequelae in blunt orbital trauma. Am J Emerg Med 2003;21:525–8. - PubMed
    1. Petro J, Tooze FM, Bales CR and Baker G Ocular injuries associated with periorbital fractures. J Trauma 1979;19:730–3. - PubMed
    1. al-Qurainy IA, Dutton GN, Ilankovan V, et al. Midfacial fractures and the eye: the development of a system for detecting patients at risk of eye injury--a prospective evaluation. Br J Oral Maxillofac Surg 1991;29:368–9. - PubMed