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. 2023 Jun;42(3):273-278.
doi: 10.1080/01676830.2022.2095648. Epub 2022 Jul 8.

Incidence and severity of asymptomatic ocular injury in adult and pediatric orbital fractures

Tyler Etheridge  1 , Ben J Brintz  2 , Michael S Jensen  1 , Esteban Peralta  1 , Azraa Ayesha  1 , Abigail Jebaraj  1 , Douglas P Marx  1
Affiliations

Incidence and severity of asymptomatic ocular injury in adult and pediatric orbital fractures

Tyler Etheridge et al. Orbit. 2023 Jun.

Abstract

Purpose: To evaluate the incidence of severe ocular injury requiring emergent ophthalmic evaluation in visually asymptomatic patients presenting with orbital fractures.

Methods: We performed a retrospective chart review of all adult and pediatric orbital fractures between 2012-2022 at a level 1 trauma center. Ocular injuries were categorized into severe, moderate, and mild. We evaluated symptoms, mechanism of injury, visual acuity (VA), and severity of injuries using the Cochran-Armitage and linear-by-linear tests.

Results: Of the 2495 cases, 1534 had ophthalmology evaluation. The mean ± standard deviation age was 40.4 ± 20.4 years. Most patients were male (73.1%) and Caucasian (75.9%). The mean time to evaluation was 0.6 ± 2.5 days. 486 (31.7%) were visually symptomatic, 760 (49.5%) were asymptomatic, and 288 (18.8%) were unknown. Of the symptomatic, 135 (27.8%) had severe injuries, 108 (22.2%) had moderate injuries, 216 (44.4%) had mild injuries, and 27 (5.6%) had no injuries. Of the asymptomatic, 67 (8.8%) had severe injuries, 183 (24.1%) had moderate injuries, 468 (61.6%) had mild injuries, and 42 (5.5%) had no injuries. Symptoms correlated with injury severity (p-value <.001). The most common mechanism of injury were falls (24.0%), assaults (22.2%), and motor vehicle accidents (14.8%).

Conclusions: Visually asymptomatic orbital fractures were less likely to have severe ocular injuries; however, many patients were unable to express symptoms. Emergent ophthalmology evaluation should be considered in all patients presenting with orbital fractures, especially patients with visual symptoms or are unable to report symptoms.

Keywords: Orbital fracture; ocular injury; trauma.

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Conflict of interest statement

Disclosure of Interest: The authors have no financial interests to disclose.

Figures

Figure 1.
Figure 1.
(A) Distribution of asymptomatic and symptomatic patients based on severity of ocular injury. The proportion of patients with symptoms varies linearly with injury severity (p-value <0.001). (B) Distribution of visual acuity (VA) based on severity of ocular injury. VA was linearly correlated with injury severity (p-value <0.001).
Figure 2.
Figure 2.
Distribution of mechanisms of injury based on the severity of ocular injury. Only gunshot wounds were correlated with injury severity. **, p-value <0.001.
See this image and copyright information in PMC

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