Association between concurrent orbital fracture and reduced glaucoma risk following ocular contusion

Ocular trauma is a recognized risk factor for glaucoma; however, how concurrent orbital injury modifies this risk remains poorly characterized. This study evaluates the long-term risk of glaucoma and traumatic glaucoma following ocular contusion (OC) and the impact of concurrent orbital fracture on these outcomes.

A retrospective cohort study was conducted using the TriNetX Research Network, which aggregates electronic health records from over 150 million patients across 112 healthcare organizations. We identified adults ≥18 years old with an OC and controls with non-orbital head trauma. Inclusion criteria required ≥1 year of follow up; patients with prior glaucoma diagnoses or concurrent globe rupture were excluded. Cohorts were matched on demographics, comorbidities, and healthcare utilization. Outcomes included diagnoses of glaucoma, traumatic glaucoma, and glaucoma suspect at 3, 5, and 20 years. Subgroup analysis was performed for patients with a concurrent orbital fracture.

8,806 patients with OC were matched to 8806 head trauma controls (all standardized differences < 0.1). OC was associated with increased risk of glaucoma (OR 1.42), traumatic glaucoma (OR 25.28), and glaucoma suspect diagnosis (OR 1.32; all p < 0.0001) at all timepoints through 20 years. Among patients with OC, concurrent orbital fracture was associated with decreased risk of all outcomes through 20 years (glaucoma: OR 0.74; traumatic glaucoma: OR 0.61; glaucoma suspect: OR 0.75; all p ≤ 0.001).

Ocular contusion is associated with sustained glaucoma risk. Concurrent orbital fracture is associated with reduced risk, possibly by dissipating traumatic forces, and may aid in glaucoma risk stratification and long-term surveillance.