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Are Orbital Fracture Location, Visual Disturbances, and Head Injury Associated With Severe Ocular and Periocular
David Lopez Oliver1, Steven Gernandt2, Romain Aymon3
1Chief Resident, Division of Ophthalmology, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine of Geneva, Genève, Switzerland.
Background:
Cranio-maxillofacial fractures involving the orbits are common and may be associated with severe ocular and periocular injuries (OPOIs) requiring prompt management.
Purpose:
The purpose of the study was to measure the association between orbital fracture (OF) location, visual disturbances (VDs), head injury (HI), and OPOI severity.
Study Design, Setting, And Sample:
A retrospective cohort study was conducted at the University Hospital of Geneva (2008-2021). Inclusion criteria are as follows: subjects ≥18 years with OF due to blunt trauma, who underwent head computed tomography, comprehensive ophthalmological assessment, and had ≥1-year follow-up.
Exclusion Criteria:
subjects <18 years, prior orbital/ophthalmic surgery, penetrating trauma, prior monocular or nonstereoscopic vision, lack of ophthalmological assessment, insufficient clinical data, or follow-up <1 year.
Predictor Variables:
Predictors included OFs (categorized by anatomic location), VD (subjective/objective visual acuity decrease or diplopia), and HI, defined as (a) loss of consciousness, (b) Glasgow Coma Scale score, and/or (c) intracranial hemorrhage.
Main Outcome Variable:
The primary outcome was OPOI severity. Severe OPOI was defined as requiring immediate ophthalmic treatment (performed without delay or within 6 hours), while nonsevere OPOI did not require immediate intervention.
Covariates:
Covariates included demographic and injury-related parameters.
Analyses:
Descriptive, bivariate, and multivariate multinomial logistic regression analyses were performed to identify factors associated with OPOIs. Statistical significance was set at P ≤ .05.
Results:
The study included 824 patients (mean age: 47.2 ± 23.6 years), the majority of whom were male (n = 580; 70.4%). Adjusted analysis showed severe OPOIs were associated with medial orbital wall fractures (odds ratio [OR], 3.54; 95% CI, 1.78-7.07; P < .01); VD (OR, 3.57; 95% CI, 1.92-6.66; P < .01); HI (OR, 1.99; 95% CI, 1.06-3.74; P = .03) and older age (OR: 1.02; 95% CI: 1.01-1.03; P < .01).
Conclusion And Relevance:
Within the limitations of the study, it appears that medial OFs, VD, HI, and older age are associated with severe OPOIs. These findings may help guide early risk assessment and management in patients with OFs.
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