Analyzing the Ophthalmological Exam in the Association Between Ocular Injuries and Orbital Fractures
Matthew Mino, MD, Bin Song, MD, Joseph Zahkary, MD, Tim King, MD, PhD, Jorge de la Torre, MD, MSHA.
University of Alabama Birmingham, Birmingham, AL, USA.
PURPOSE: This study investigates the incidence of ocular injuries associated with orbital fractures but, unlike previous work, takes a more comprehensive look at the ocular exam and investigates the treatment recommendations made by the ophthalmologist consultant.
METHODS: This study was a retrospective review of 288 patients with both orbital fractures and an ophthalmological exam seen between 2013 and 2015 at the University of Alabama at Birmingham Emergency Center. Patient charts were reviewed for age, gender, race, method of injury, side of fracture (right, left, bilateral), associated facial fractures and lacerations, and findings of the ophthalmologic exam. Additionally, if multiple visits were required for diagnosis or if prescription medications were recommended, these findings were also included.
RESULTS: 288 patients with both orbital fractures and an ophthalmological exam were evaluated: 73.3% were male and 26.7% female. The average age was 44 (range 16-91). Of patients seen with orbital fractures, 50.9% had an associated ocular injury. Fourteen percent of patients were intubated during their initial exam. Dilation was deferred in 16.6% of patients. Of the 288 patients, 45.8% had a right-sided orbital fracture, 42.7% had a left-sided, and 11.4% had bilateral. Twenty eight percent required multiple visits for a full exam to be completed or to follow an injury, and 16% were prescribed medication for treatment. From the 288 patients, 322 orbital fractures were identified. Ten open globes required urgent surgery and 3 patients required canthotomy and cantholysis. Despite the presence of bilateral ocular injuries in patients with unilateral fractures, a unilateral fracture was significantly associated with an ocular injury compared to the non-fractured eye (p < 0.0001). Additionally, visual acuity (VA) greater than 20/30 and restricted extra-ocular muscle movement (EOM) were significantly associated with ocular injury (p<0.0001 and 0.038). Multiple walls broken, facial lacerations, and tono-pen pressure greater than 21 were not significantly associated with ocular injury.
CONCLUSION: For clinicians treating patients with orbital fractures, visual acuity and extra-ocular muscle movement can raise concerns that a patient may be at risk for ocular injury. Although only patients with open globes required urgent surgery in this review, 16% of patients were recommended prescription medication by ophthalmology and 28% required multiple visits during their hospitalization. Unlike previous studies, multiple walls broken was not associated with a trend towards increased ocular injury.
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