Assessment and Validation of a Predictive Model for Severe Ocular Injuries Associated With Orbital Wall Fractures

Severe ocular injuries (SOI) can occur in orbital wall fractures and may be overlooked in acute care. Recognition of factors associated with SOI may improve patient outcomes.

This study aimed to create and validate a predictive model for SOI in orbital wall fractures.

This is a retrospective cohort study. To create the training predictive model, the investigators screened a study population composed of all patients who presented to Farabi Eye Hospital between 2016 and 2023 for the evaluation and management of orbital wall fractures. The exclusion criteria were the absence of an ophthalmologic examination or an orbital computed tomography report. The validation model was composed of an external dataset that included 97 subjects.

The predictor variables were trauma details, uncorrected visual acuity (UCVA), lid laceration, conjunctival hemorrhage, computed tomography scan features, including the number of herniated extraocular muscles (EOMs).

The main outcome variable was the presence of SOI, including open globe injuries, optic nerve-related injuries, and severe closed globe injuries.

The covariates were age and sex.

Multivariable logistic regression was performed to identify factors associated with SOI. Model performance was assessed using the area under the receiver operating characteristic curve, specificity, and negative predictive value (NPV) in an external validation dataset. Statistical significance was set at P < .05.

The sample consisted of 537 subjects, with a mean age of 29.8 ± 13.91 years, and 22.7% (124) were female. The multivariable regression analysis revealed that the 4 main variables associated with SOI were: trauma setting (odds ratio [OR] = 2.61, 95% CI 1.1 to 6.21), UCVA (OR = 4.45, 95% CI 2.65 to 6.27), conjunctival hemorrhage (OR = 4.07, 95% CI 1.21 to 3.49), and herniated EOMs (OR = 1.77, 95% CI 1.2 to 2.61). In the training set, the specificity and NPV were 76.8 and 85.5%, respectively. This model achieved an area under the receiver operating characteristic curve of 0.77 for the subset of closed-globe injuries. When applied to the validation set, the model achieved a specificity of 76.6% and an NPV of 86%.

We identified that trauma setting, reduced UCVA, conjunctival hemorrhage, and herniated EOMs are associated with SOI in orbital fractures.