Evidence-Based Protocol for Ophthalmology Consult for Orbital Fractures

Area of Science:

• Ophthalmology
• Oral and Maxillofacial Surgery
• Evidence-Based Medicine

Background:

• Urgent ophthalmologist evaluation for orbital fractures is often standard practice, even in visually asymptomatic patients.
• Previous studies suggest non-urgent consultation may be appropriate, but institutional protocols vary.

Purpose of the Study:

• To determine the necessity of preoperative ophthalmology consultation for surgically repaired orbital fractures in visually asymptomatic patients.
• To develop an evidence-based protocol for ophthalmology consults in this patient population.

Main Methods:

• Retrospective review (2012-2017) of surgically repaired orbital fractures without preoperative ophthalmology consult.
• Prospective study (2019-2020) with a protocol to identify patients needing preoperative ophthalmology consult.
• Assessment of visual acuity, extra-ocular movements, and diplopia pre- and postoperatively.

Main Results:

• In the retrospective group, 98% of patients had normal postoperative exams without prior consultation.
• In the prospective group, 90% of patients not requiring a preoperative consult had normal postoperative outcomes.
• A small percentage of patients (2-7%) experienced new or persistent diplopia postoperatively, regardless of consultation status.

Conclusions:

• Routine ophthalmology consultation is not warranted for visually asymptomatic patients with orbital fractures undergoing surgical repair.
• An evidence-based protocol can safely guide ophthalmology consults, reducing unnecessary evaluations.