GP1d - Ocular Injuries Associated With Orbital Fractures

Abstract: Facial trauma teams often consist of non-standardized involvement of multiple disciplinaries allowing for greater inefficiency of resource allocation. The purpose of this study was to determine the frequency and severity of ocular injury in patients with facial trauma, and thereby facilitate appropriate involvement of ophthalmic specialists in their care. This retrospective study was conducted in North America at a Level I trauma center (Boston Medical Center). Data was collected from the electronic medical records of patients who had presented to the Emergency Department with maxillofacial fractures involving the orbit (ICD-10 codes S02.121-S09.93Xa) in the period 2019-2021. In addition to computed tomograms, inclusion was limited to those with a documented eye examination. Eye injuries were classified according to their potential for causing long-term visual disturbance as ‘major’ (corneal abrasion, traumatic iritis, traumatic optic neuropathy, retrobulbar hematoma, hyphema, traumatic mydriasis, open globe, vitreous hemorrhage), or ‘minor’ (chemosis, subconjunctival hemorrhage, traumatic nuclear sclerosis, superficial punctate epithelial erosions, superficial punctate keratitis, commotio retinae). The frequency and severity ocular injury, mechanism of injury causing orbital trauma and orbital fracture pattern was then correlated. During the study period, a series of 480 patients with a total of 519 consecutive orbital fractures confirmed by CT and a recorded ophthalmic exam were included in the study. The most common mechanism of injury was assault, followed by falls and motor vehicle accidents. 253 of the 480 patients were recorded with ocular injuries, of which 63 (13%) patients were classified with ‘major’. These included 4 open globe, 5 traumatic optic neuropathy, 32 retrobulbar hematomas, 4 hyphemas, 10 traumatic iritis, 4 impaired extraocular movements, and 1 traumatic mydriasis. In 157 orbital fractures, there was involvement of the zygomatico-maxillary complex. Major ocular injury was less common (15/157, 10%) among orbital fractures with ZMC fractures than those without (50/362, 14%). Ocular trauma was seen commonly to accompany fractures of the orbit. This was seen more in fractures of the ZMC. Most of these injuries are minor, but a significant minority have the potential to result in ongoing visual impairment. Our results suggest that ophthalmologic review should be obtained routinely in patients having sustained orbital trauma, particularly if this involves the zygomatico-maxillary complex.