Orbital fractures are a poor prognostic factor in open globe injuries

There exist an increased risk of enucleation or evisceration or a visual acuity corresponding to no light perception.

Blowout Fracture Of The Left Eye

Computed tomography of the skull shows an orbital floor fracture of the left eye. (Source via CC Attribution Share-Alike 3.0)

Fractures of the zygomatic and maxillary bones and skull base are more likely to be associated with eye injuries, such as a ruptured globe, retrobulbar hemorrhages, hyphema, scleral tears, and hemorrhagic glaucoma. Visual outcomes may range from 20/20 to an inability to perceive light (NLP, no light perception). Previous studies have identified risk factors for visual prognostication after trauma, although orbital fractures did not always make the list.

This retrospective study aimed to test the hypothesis that patients with open globe injuries and orbital fractures had poorer visual recovery. Charts of 77 patients were reviewed, and multivariate regression analysis was done to assess the effect of individual patient factors.

Results showed that patients with both an open globe and orbital fracture more probably had blunt trauma, versus exclusively open globe injuries that came likely from penetrating forces. When orbital fractures are present, the wounds tend to be more posterior. Orbital floor and roof fractures were the most and least common, respectively, although the latter most often presented with NLP vision. With an orbital fracture present, there was an increased risk of later evisceration or enucleation (OR: 4.6, 95% CI 1.3-20.1) and NLP vision (O: 6.81, 95% CI 2.42-21.85).

This study definitively showed that concomitant orbital fractures in patients with open globes are an independent risk factor for poor prognosis. Such information will be useful in educating patients about their outcomes, even prior surgery and open globe repair.

Eric D. Gaier, Sami Tarabishy, Christopher Bayers, Natalie Wolkow, Matthew Gardiner, Daniel R. Lefebvre & Seanna Grob (2019): Poor prognoses of open globe injuries with concomitant orbital fractures, Orbit, DOI: 10.1080/01676830.2019.1663881

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