Ocular injury in orbital fractures at a level I trauma center

To determine the acuity of ophthalmology referral for orbital fractures.

This is a retrospective chart review of 73 cases of orbital fractures over a 1-year period at a level I trauma centre. All consultations including those for orbital fractures were included in the study. The age and sex of the patient, date and time of initial emergency room (ER) arrival, date and time of input of the ophthalmology consultation, date and time the patient actually saw ophthalmology, reasons for consultation, location of examination, mechanism, and ocular findings at initial and follow-up examination, and any orbital surgery performed were recorded.

Of the 73 patients referred, 10 had an ocular abnormality on examination. Of the 65 routine referrals for orbital fracture received, 5 had an ocular abnormality on examination, whereas 5 of the 8 patients referred for an ocular abnormality in addition to the orbital fracture had an ocular abnormality, for an overall rate of 13.7%. Of the routine referrals, none had severe ocular injuries, such as globe rupture or retrobulbar hemorrhage, requiring immediate ocular intervention.

Orbital fractures may be associated with severe ocular abnormalities, although routine cases of orbital fractures in the absence of suspicion of serious ocular injury may be less likely to have abnormalities requiring emergent evaluation by an ophthalmologist. A prospective study evaluating orbital fractures would help clarify this.