The Frequency of Decreased Visual Acuity in Orbital Fractures

The aim of this systematic review is to summarize and evaluate the effect of orbital fractures (blowout fractures and nonblowout fractures) on visual acuity. In PubMed search and Scopus search, the terms "orbital fracture OR maxillofacial injury OR facial trauma OR craniofacial fracture," and "visual acuity OR functional outcome OR visual outcome OR improving document of visual acuity OR blindness OR optic nerve neuropathy" were used, which resulted in 1634 and 1152 papers, respectively. Of the 2226 titles excluding 560 duplicated titles, 227 abstracts were reviewed. Of the 227 abstracts reviewed, the authors found 56 potentially relevant full-text articles, of which 5 studies met our inclusion criteria. The odds ratio and 95% confidence intervals from each study were abstracted. The statistical analysis was performed with review manager (The Nordic Cochrane Centre). A summary of 5 studies affirmed that 43 patients among 532 orbital fractures (8.1%) had decreased visual acuity. Twelve patients among 159 blowout fractures (7.5%) had decreased visual acuity. Thirty-one patients among 373 orbital fractures other than pure blowout fractures (8.3%) had decreased visual acuity. In orbital fractures other than pure blowout fractures, the frequency of decreased visual acuity was higher than pure blowout fractures (n = 532, odds ratio, 2.23, 95% confidence interval = 1.06-4.70). Surgeons should acknowledge this with patients before surgery.