Concomitant Traumatic Macular Hole and Orbital Fracture

Area of Science:

• Ophthalmology
• Trauma Surgery
• Radiology

Background:

• Orbital fractures are common injuries.
• Traumatic macular holes (TMH) can result from blunt ocular trauma.
• The co-occurrence of TMH and orbital fracture is infrequently reported.

Purpose of the Study:

• To report 5 cases of concomitant traumatic macular hole (TMH) and orbital fracture.
• To determine the incidence of this combined injury.
• To discuss the potential protective role of orbital fractures in blunt trauma.

Main Methods:

• Retrospective observational study of patients with orbital fractures (May 2013-December 2023).
• Analysis of axial and coronal orbital CT scans (bone and soft tissue windows).
• Inclusion of optical coherence tomography (OCT) images for all patients.

Main Results:

• Five cases (0.4%) of concomitant TMH and orbital fracture identified among 1,152 patients.
• All injuries resulted from baseball/softball trauma.
• TMH stages ranged from 1b to 4, associated with various orbital fracture locations (medial wall, floor, or both).

Conclusions:

• The incidence of concomitant TMH and orbital fracture is low (0.4%).
• Orbital fractures may offer a protective effect against severe ocular trauma in blunt impacts.
• Baseball and softball impacts are identified as specific mechanisms increasing the risk for this dual injury.