Risk Factors for Ocular Complications Following Orbital Fractures: A Large-Scale Multivariate Analysis

We aimed to evaluate the risk factors of ocular complications associated with orbital fractures in a large cohort of patients.

In this retrospective study, we analyzed the medical records of 1416 consecutive orbital fracture patients treated at Kyoto Prefectural University of Medicine, Kyoto, Japan between March 2009 and April 2025. Fracture characteristics, causes of injury, and the frequency of ocular complications were assessed via clinical records and associated computed tomography scan images. The factors associated with ocular complications were evaluated with multivariate logistic regression analysis.

Ocular complications occurred in 9.5% of the cases, with traumatic mydriasis, hyphema, and commotio retinae being the most common. Multivariate logistic regression identified sports-related injury (OR,2.19; 95% CI, 1.73-2.77, p < .01), male sex (OR,1.51; 95% CI, 1.12-2.03, p < .01), non-trapdoor fracture (OR,1.34; 95% CI, 1.01-1.80, p < .05), combined medial wall and orbital floor fractures (OR,1.32; 95% CI, 1.05-1.67, p = .02) and zygomatic or maxilla bone fracture (OR,1.34; 95% CI, 1.00-1.79, p < .05) as independent predictors of ocular complications. Sports-related injury, particularly those associated with golf and baseball, showed the highest rate of ocular complications, with golf-related orbital fractures resulting in a 100% complication rate and baseball-related orbital fractures resulting in a 38.1% complication rate.

Sports-related injuries, male sex, non-trapdoor fractures, combined medial wall and orbital floor fractures and zygomatic or maxilla bone fracture are risk factors for ocular complications. Golf and baseball related orbital fractures are associated with a particularly high incidence of ocular complications, and urgent ophthalmologic examination is warranted in these cases.