Factors Associated With Increased Risk of Serious Ocular Injury in the Setting of Orbital Fracture

Rossin, Elizabeth J.; Szypko, Colleen; Giese, Isaiah; Hall, Nathan; Gardiner, Matthew; Lorch, Alice C.

doi:10.1001/jamaophthalmol.2020.5108

Cited by 18 publications

(27 citation statements)

References 23 publications

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“…Other investigators have suggested that pain with eye movements and restricted motility are predictive of severe ocular trauma. 11,16 In our study, pain with eye movements and restricted motility were also not associated with severe injury, likely due to the absence of extraocular muscle entrapment in our cohort.…”

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confidence: 47%

“…Diplopia has been noted by some to potentially indicate more severe ocular injury. 11,16 By contrast, when we analyzed diplopia as an isolated symptom, we did not establish this same association. Other investigators have suggested that pain with eye movements and restricted motility are predictive of severe ocular trauma.…”

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confidence: 64%

“…Acuity of consultation was based on injury severity, which was based on previous literature. [14][15][16] Patients were categorized by their most severe injury. "Severe" injuries comprised hyphema, globe rupture, vitreous hemorrhage, traumatic optic neuropathy, and retrobulbar hemorrhage.…”

Section: Methodsmentioning

confidence: 99%

“…Clinical Ophthalmology 2022:16 4154 injuries (eyelid laceration, conjunctival laceration, corneal abrasion, traumatic iritis, microhyphema, iris sphincter tear, commotio retinae, retinal hemorrhage) required "expedited" ophthalmologic evaluation within a few hours, but not necessarily immediately. 16 The remaining patients with "mild" injuries (periorbital swelling, periorbital ecchymosis, eyebrow laceration or abrasion, conjunctival injection, chemosis, and subconjunctival hemorrhage) could undergo more routine or "non-urgent" ophthalmologic consultation. Such non-urgent consultation should still be within 24 hours, in our estimation, for an eye specialist to confirm the initial impression of only mild ocular injury.…”

Section: Dovepressmentioning

confidence: 99%

“… 14 , 15 Diplopia is one symptom that has long been thought of as an indicator of extraocular muscle entrapment and suggests ocular injury. 11 , 16 More recent studies by Richani et al have suggested that pain with eye movements, blurry vision, and motility restriction were predictive of severe ocular injury. 15 Rossin et al integrated poor VA, diplopia, mechanism of injury, and location of fracture into an algorithm that, when combined with additional findings of chemosis and conjunctival hemorrhage, can foretell a higher risk of “substantial” ocular injury, defined as injuries requiring urgent or close follow up.…”

Section: Introductionmentioning

confidence: 99%

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Orbital Fractures and Risk Factors for Ocular Injury

Zhong¹,

Chou²,

Chaleff³

et al. 2022

OPTH

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To identify factors predictive of serious ocular injury requiring urgent consultation by ophthalmology in patients presenting with blunt trauma orbital fractures. Methods: This is a retrospective study of adult patients diagnosed with orbital fractures after blunt trauma at a university medical center emergency room. Patient records were examined over a three-year period. Data including mechanism of injury, fracture location, ocular symptoms, and examination findings were recorded. Ocular injuries were divided into three levels of severity: mild, moderate, and severe. Fracture characteristics, patient demographics, and examination findings were analyzed using multinomial regression to identify risk factors for more severe injury. Results: One hundred and eighty-six patients met inclusion criteria. For 29.6% of patients, urgent ophthalmologic consultation was required. Ruptured globes occurred in 2.2% of injuries. There was a statistically significant association between severe ocular injury and three examination findings: poor vision (OR 14.5; p < 0.001), afferent pupillary defect (OR 44.8; p < 0.001), and abnormal pupillary reaction (OR 28.0; p < 0.001). Likewise, blurry vision (OR 3.6; p = 0.018), ocular pain (OR 3.7; p = 0.011), and facial pain (OR 4.4; p = 0.031) were also associated with an increased risk of severe ocular injury. Abnormal pupillary reaction was associated with moderate injury (OR 4.5; p = 0.041). Demographic factors, mechanism of injury, anti-coagulant use, fracture location, diplopia, no documented vision, subconjunctival hemorrhage, chemosis, and motility restriction were not associated with injury severity. Conclusion:Most patients who presented to the emergency room with an orbital fracture did not require urgent ophthalmologic consultation. The presence of blurry vision, ocular pain, facial pain, poor vision, and afferent pupillary defect significantly increased the odds of severe injury. Abnormal pupillary reaction was associated with both moderate and severe injury.

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confidence: 47%

mentioning

confidence: 64%

Section: Methodsmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Orbital Fractures and Risk Factors for Ocular Injury

Zhong¹,

Chou²,

Chaleff³

et al. 2022

OPTH

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The Big Influence of Small Data in Emergency Assessment of Serious Ocular Injury

Herman

2021

JAMA Ophthalmol

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Characteristics of Orbital Injuries Associated with Maxillofacial Trauma

et al. 2022

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Introduction The incidence of ocular injury associated with maxillofacial trauma remains poorly defined, with reported rates ranging from 0.8% to 92%. Our study aims to more accurately characterize ocular injuries associated with midface fractures. Methods We performed a retrospective review of 1677 patients from 2015 to 2020 with midface fractures at a Level I trauma center. Isolated nasal bone and frontal process of the maxilla fractures were excluded. Demographic information, mechanism of injury, need for surgery, and ophthalmologic findings were documented. Statistical analysis was conducted using SPSS. Results 773 patients between the ages of 15 and 92 were identified. Trauma most commonly resulted from assault (63.8%). The association between the mechanism of injury and ocular injury was statistically significant (p = 0.003), with 78.6% of gunshot wounds and 44.3% of assault patients having an ocular injury. The Ophthalmology service evaluated 62.6% of cases preoperatively. Minor ocular injury occurred in 36% of patients, including 46.1% of isolated orbital floor, and 28.2% of zygomaticomaxillary complex fractures. Major ocular injury occurred in 10.5% of patients. Conclusions Over 10% of patients with midface fractures were found to have major ocular injuries. Ophthalmologic exams should be performed for all patients with midface fractures to guide clinical decision making and prevent further intraoperative ocular insults. Level of Evidence Level 4. This study represents a retrospective cohort study analyzing ocular injuries detected in patients presenting to a Level I trauma center with maxillofacial fractures between 2015 and 2020 Laryngoscope, 133:1624–1629, 2023

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Factors Associated With Increased Risk of Serious Ocular Injury in the Setting of Orbital Fracture

Cited by 18 publications

References 23 publications

Orbital Fractures and Risk Factors for Ocular Injury

Orbital Fractures and Risk Factors for Ocular Injury

The Big Influence of Small Data in Emergency Assessment of Serious Ocular Injury

Characteristics of Orbital Injuries Associated with Maxillofacial Trauma

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