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. 2020 Sep 24:14:2837-2842.
doi: 10.2147/OPTH.S274567. eCollection 2020.

Review of Ocular Injuries in Patients with Orbital Wall Fractures: A 5-Year Retrospective Analysis

Stephanie B Terrill  1 , Hyelin You  2 , Heidi Eiseman  1 , Michael E Rauser  1
Affiliations

Review of Ocular Injuries in Patients with Orbital Wall Fractures: A 5-Year Retrospective Analysis

Stephanie B Terrill et al. Clin Ophthalmol. .

Abstract

Purpose: The purpose of this study was to determine the incidence of minor and major ocular injuries in patients with orbital wall fractures at Loma Linda University Health, a level-one trauma center, to help determine the most appropriate setting for the initial dilated fundus examination by ophthalmologists.

Methods: A retrospective study was performed from January 2008 to January 2013 of patients diagnosed with orbital wall fracture secondary to trauma. Exclusion criteria included unknown mechanism of injury, the absence of ophthalmology consultation, or absence of imaging. Data collected included age, gender, mechanism of injury, visual acuity, and anterior/posterior segment findings. Ocular injuries were categorized as either minor or major.

Results: Of 567 charts reviewed, 460 met criteria and were included for analysis. In the analysis, 86.5% of patients were male, and 81.3% were Caucasian. The most common mechanism of orbital fracture was blunt injury. Visual acuity was better than 20/100 in 82.4% of patients. On chart review, 81.1% of patients were found to have either a minor injury, a major injury, or both. The most common injury was subconjunctival hemorrhage (53.5%). Globe rupture (2.9%) and vision-threatening posterior segment findings such as retinal tear and choroidal rupture (1.3%) were relatively rare. Only one retinal detachment (0.2%) was found, specifically in the setting of severe injury with concomitant globe rupture.

Conclusion: Knowledge of the common ocular injuries associated with orbital fractures will help emergency department (ED) physicians and ophthalmologists provide the dilated fundus exam in the most appropriate setting. The most frequent injuries identified were non-vision threatening, and visually significant posterior segment findings were relatively rare (1.3%). Thus, for the majority of patients presenting to the ED with orbital fracture, a dilated fundus exam can be performed at a later date in the outpatient clinic setting, unless urgent orbital fracture surgery is planned.

Keywords: entrapment; globe rupture; ocular trauma; orbital wall fracture; subconjunctival hemorrhage; vision loss.

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Conflict of interest statement

The authors report no conflicts of interest in this work. The abstract of this paper was presented at the ARVO Annual Meeting as a poster presentation/conference talk with interim findings. The poster’s abstract was published in ARVO Annual Meeting Abstracts in Investigative Ophthalmology & Visual Science: https://iovs.arvojournals.org/article.aspx?articleid=2268143.

Figures

Figure 1
Figure 1
Mechanism of injury.
See this image and copyright information in PMC

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