Intraocular pressure as an index of ocular injury in orbital fractures

An improved method of screening for ocular injuries in patients sustaining orbital fractures is proposed. We performed a retrospective study of 107 patients who sustained orbital fractures. Intraocular pressures were measured on presentation in 17 patients and were found to be elevated on the side of the injury in eight patients, five (63%) of whom had significant ocular injury. No patient with normal intraocular pressure was found to have an ocular injury. In a prospective study, the intraocular pressures of 30 patients sustaining orbital fractures were measured. Twelve patients (40%) had normal (less than 22 mm Hg) and bilaterally symmetric (less than 3 mm Hg difference) intraocular pressures. One (8%) of these patients sustained ocular injury. In contrast, 18 patients (60%) had either an elevated intraocular pressure (greater than 22 mm Hg) or a difference between eyes of greater than or equal to 3 mm Hg. Eleven (61%) of these patients were found to have sustained an ocular injury. We conclude that intraocular hypertension or significant interocular pressure differences should alert the physician to a potential ocular injury.