Evidence-Based Protocol for Ophthalmology Consult for Orbital Fractures

Previous retrospective studies demonstrate that urgent evaluation by an ophthalmologist for orbital fractures is not required in visually asymptomatic patients, although a consult is often seen as a necessity in many hospital institutions. To determine when an ophthalmology consult is indicated for a surgical patient, the oral and maxillofacial and ophthalmology departments at 1 institution collaborated for an evidence-based approach utilizing retrospective and prospective data.

The retrospective arm looked at patients from 2012 to 2017, who had an isolated, surgically repaired orbital fracture without preoperative ophthalmology consultation. A prospective arm was then created from August 2019 to July 2020 with a designed protocol that determined which patients required an ophthalmology consult preoperatively. Extra-ocular movements, visual acuity, and diplopia were examined in the preoperative and postoperative setting to determine if the lack of an ophthalmology consult adversely affected patient outcome.

Of the retrospective patients who met criteria, 82 of the 84 (98%) patients had a normal postoperative examination: baseline visual acuity, intact extra-ocular movement, and no diplopia. The 2 of the 84 (2%) patients had postoperative diplopia consistent with preop examination. In the prospective group, 10 of the 39 patients required a preop ophthalmology consult while 29 of 39 did not require one. A normal postoperative examination was present in 26 of the 29 patients (90%). Of those 3 remaining patients, 2 patients (7%) had postoperative diplopia consistent with preoperative while 1 patient (3%) had postoperative diplopia without preoperative diplopia.

The authors conclude that a routine ophthalmology consult is not warranted in visually asymptomatic patients with orbital fractures requiring surgical repair.