Primary Assessment of the Patient With Orbital Fractures Should Include Pupillary Response and Visual Acuity Changes to Detect Occult Major Ocular Injuries

Chow, Jeffrey; Parthasarathi, Krishnan; Mehanna, Patrick; Whist, Eline

doi:10.1016/j.joms.2018.04.024

Cited by 12 publications

(14 citation statements)

References 16 publications

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“…With respect to the mechanism of injury, a prospective study by al-Qurainy et al found assault to be the highest percentage (49.9%), while falls and road traffic accidents accounted for 19% and 12.4%, respectively-values comparable to a more recent study performed by Chow et al (48%, 17%, and 21%, respectively). 5,9 Conversely, Amrith et al reported road traffic accidents to account for the largest proportion, at 36.5%, while the percentage for assault was 12.5%. 11 In this study, blunt trauma was found to be the cause of 48.3% of cases while the percentage of falls and motor vehicle accidents were found to be 24.3% and 25.4%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have reported that patients with penetrating trauma, visual acuity deficits, afferent pupillary defects, and posterior orbital fractures were at highest risk for vision loss. 8 , 9 Additionally, Richani et al identified four signs and symptoms to be predictors of severity—blurred vision, pain with eye movement, poor visual acuity, and restricted mobility—with the presence of two or more of these signs being predictive of severe ocular trauma, indicating the need for urgent ophthalmologic consultation. 10 This is consistent with the results of our study which demonstrates that visual acuity deficits can be an indicator of potential serious ocular injury as 12 of the 13 (92.3%) patients with ruptured globes were found to have VA of 20/800 or worse.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Terrill¹,

You²,

Eiseman³

et al. 2020

OPTH

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Terrill¹,

You²,

Eiseman³

et al. 2020

OPTH

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“…Although many have studied this topic, a sound method for predicting ocular injury that is accessible to the nonophthalmologist is lacking. Many large case series estimate the rate of ocular complication but do not offer a strategy for prediction . Some studies have suggested that subjective visual symptoms, objective visual acuity, or pupillary light reflex can be used to screen for ocular injury; however, most studies are small, do not specifically measure the accuracy of their predictive factors, are based partially on outpatient follow-up, and the predictive factors are not easily collected in the acute emergency setting.…”

Section: Introductionmentioning

confidence: 99%

“…Many large case series estimate the rate of ocular complication but do not offer a strategy for prediction. [3][4][5][6][7][8][9][10][11] Some studies have suggested that subjective visual symptoms, objective visual acuity, or pupillary light reflex can be used to screen for ocular injury 2,3,5,8,9,12 ; however, most studies are small, do not specifically measure the accuracy of their predictive factors, are based partially on outpatient follow-up, and the predictive factors are not easily collected in the acute emergency setting. A test that is specifically IMPORTANCE Orbital fractures are common in ocular trauma, and there is a need to develop predictive tools to estimate risk of concurrent ocular injury.…”

mentioning

confidence: 99%

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

et al. 2021

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“…Ν αυ άΝ βθΝ π λέπ ω βΝ ηπολοτη Ν ηΫ ωΝ βμΝ αθ λο οηέαμΝ θαΝ δ Ϊΰουη Ν ΫθαθΝ εαγ άλαΝ η Ν α λογΪζαηοΝ υπσΝ οΝ Ϋ αφομΝ ουΝ εα αΰ ΰσ ομΝ ΪφουμΝ ουΝ οφγαζηδεοτΝ εσΰχουΝ εαδΝ θαΝ λυγηέ ουη Ν οΝ τοομΝ αυ οτέΝ ΓδαΝ βθΝ πλο α έαΝ ουΝ ε λα ο δ οτμΝ δ ΰχ δλβ δεΪΝ απσΝ ουμΝ χ δλδ ηοτμΝ ηπολ έΝ θαΝ δ θ λΰβγ έΝ πλο ωλδθάΝ αλ ολλαφάΝ άΝ οπογΫ β βΝ ε λΪ δθουΝ εαζτηηα ομ (Alinasab B et al, 2018, Duguid IM et al, 1982, Kang DH et al, 2019, Kim JS et al, 2016, Nazimi AJ et al, 2019, Shokri T et al, 2019. Αιέα δΝθαΝ βη δπγ έΝσ δΝ ΝεΪγ Νπ λέπ π βΝεα αΰηΪ πθΝ κυΝκφγαζηδεκτ εσΰξκυΝ απαδ έ αδΝ ζ π κη λάμΝ κφγαζηκζκΰδεάΝ ιΫ α βΝ ΰδαΝ υξσθΝ κφγαζηκζκΰδεάΝ γ λαπ υ δεάΝαθ δη υπδ β (Chow J et al, 2018, Nazimi AJ et al, 2019.…”

Section: κα ϊΰηα α Le Fort IIunclassified

Συμβολή Στη Μελέτη Συσχέτισης Μεταξύ Της Χρήσης Ζωνών Ασφαλείας-Κράνους Και Του Βαθμού Βαρύτητας Καταγμάτων Του Σπλαχνικού Κρανίου

Αργύρης¹

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Traffic accidents are one of the most common causes of morbidity and mortality worldwide, especially in the productive ages. Injuries-fractures of the visceral skull are quite common as a result of a traffic accident. The positive impact of the use of seatbelts and helmets in reducing mortality and morbidity in drivers and passengers of cars and motorcycles, respectively, is well known and obvious. The main purpose and object of this study was the correlation between the severity of fractures of the visceral skull in patients who suffered a traffic accident and the use of seatbelts and helmets. A secondary goal was the correlation between the grade of rehabilitation of visceral skull fractures and the use of seatbelts and helmets. The skull is divided into the cerebral and the visceral skull. The bones of the visceral skull include: nasal bones, maxillas, palatine bones, zygomatic bones, mandible, inferior nasal conchaes, vomer, lacrimal bones. The frontal bone, although involved in the formation of the face, belongs to the bones of the cerebral skull. Although the ethmoid bone is involved in the formation of the median orbital wall and the paranasal sinuses, it is considered by many to belong to the bones of the cerebral skull. In this study, the following types of fractures of the visceral skull were assessed according to their location: fractures of the nasal bones and bony nasal pyramid, naso-orbitalethmoid (NOE) fractures, fractures of the zygomatic complex, fractures of the maxillary bone (walls of maxillary sinus, dentoalvelar), mandibular fractures (symphysis / parasymphysis, body, angle, ramus, condylar / subcondylar, coronoidprocess, dentoalveolar), Le Fort fractures (I, II, III, bilateral or unilateral, combined or not), temporomandibular fractures, panfacial fractures. The study involved 120 patients who suffered fractures of the visceral skull after a traffic accident as drivers or passengers of cars or motorcycles and were treated in fully or partially at the University General Hospital of Ioannina from 2015 to 2019. These were 92 men and 28 women. The initial parameters collected, measured and related to the patient and the accident were: age, sex / gender, date of the accident, type of vehicle (car or motorcycle), role / position of the patient in the vehicle (driver or passenger), use or nonuse of safety device (seatbelt or helmet), alcohol effect. The severity of visceral skull fractures was categorized into three severity grades: mild, moderate, high. Mild severity fractures of the visceral skull included: fractures of the bony nasal pyramid, fractures of the walls of the maxillary sinus (except the roof), fractures of the maxillary alveolar processes, mandibular fractures (not including condyle or coronoid process), condylar fractures (without coexisting another fracture in the mandible), fractures of the coronoid process (without coexisting another fracture in the mandible). Moderate severity fractures of the visceral skull included: mandibular fractures involving the condyle or coronoid process and one or more of its other parts (including the possible combination of condylar fractures and fractures of coronoid process), pure fractures of the orbital floor (blow-out & blow-in), zygomatic complex fractures, Le Fort I fractures (including semi-Le Fort I). The coexistence of 2 or more fractures from the following categories was also classified in this grade of severity: fractures of the bony nasal pyramid, fractures of the walls of the maxillary sinus (except the roof), fractures of the maxillary alveolar processes, mandibular fractures. High severity fractures of the visceral skull included: naso-orbital-ethmoid fractures, Le Fort II fractures (including semi-Le Fort II), Le Fort III fractures (including semi-Le Fort III), combined Le Fort fractures, panfacial fractures. Additionally, the parameter of average or total grade of severity of fractures of the visceral skull for each group of patients was created and was equal to the sum of the severity grades for each patient in the group separately by the number of patients in this group. For reasons of completeness, the presence or absence of concomitant injuries in areas other than the visceral skull was also assessed. With regard to the treatment of fractures of the visceral skull, the following parameters were assessed and measured: surgical treatment (presence or absence), date of first or unique surgery, time in days between traffic accident and first or unique surgery, post-operative days of hospitalization, one or more revision surgeries (presence or absence). To assess the grade of rehabilitation of fractures of the visceral skull, criteria were created which could be measured (presence or absence) before and after possible treatment and were as follows: mandibular mobility disorder, maxillary mobilitydisorder (or paradoxical mobility), dental occlusion disorder (malocclusion), cosmetic disorder (strictly due to fractures of the visceral skull). The grade of rehabilitation for each criterion separately could take the following values: complete, partial / none. The overall grade of rehabilitation of fractures of the visceral skull could take one of the following values: complete, partial, none. The results of this study were divided into two categories: drivers and passengers of cars, drivers and passengers of motorcycles. Regarding the group of drivers andpassengers of cars, the following were the main conclusions: The absence of seatbelt use is associated with an increase in the grade ofseverity of fractures of the visceral skull, a relationship that was statistically significant (p<0.05). The absence of seatbelt use is associated with an increased need for surgical treatment of visceral skull fractures, a statistically significant relationship (p<0.05). Additionally, the absence of seatbelt use is associated with an increased need for 2 or more surgeries to treat visceral skull fractures, but this relationship was not statistically significant (p>0.05). The presence of seatbelt use is associated with a higher grade of rehabilitation of visceral skull fractures, but this relationship that was not statistically significant (p>0.05). Regarding the group of drivers and passengers of motorcycles, the following were the main conclusions: The absence of helmet use is associated with an increase in the grade of severity of fractures of the visceral skull, a relationship that was statistically significant (p<0.05). The absence of helmet use is associated with an increased need for surgical treatment of visceral skull fractures, a statistically significant relationship (p<0.05). Additionally, the absence of helmet use is associated with an increased need for 2 or more surgeries to treat visceral skull fractures, but this relationship was not statistically significant (p>0.05). The presence of helmet use is associated with a higher grade of rehabilitation of visceral skull fractures, but this relationship was not statistically significant (p>0.05). The results of our study demonstrate the value of using seatbelt and helmet inpreventing and reducing the morbidity of patients who have been involved in a traffic accident, especially in terms of visceral skull fractures. We hope future studies to be conducted with similar goals, which will probably overcome possible weaknesses of our study and with their conclusions will once again confirm the value of the use of seatbelts and helmets by drivers and passengers of cars and motorcycles respectively further consolidating their use.

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Primary Assessment of the Patient With Orbital Fractures Should Include Pupillary Response and Visual Acuity Changes to Detect Occult Major Ocular Injuries

Cited by 12 publications

References 16 publications

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

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

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

Συμβολή Στη Μελέτη Συσχέτισης Μεταξύ Της Χρήσης Ζωνών Ασφαλείας-Κράνους Και Του Βαθμού Βαρύτητας Καταγμάτων Του Σπλαχνικού Κρανίου

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