Orbital fractures and ocular injury: is a postoperative ophthalmology examination necessary?
OBJECTIVE
To determine whether formal ophthalmology evaluation is necessary after operative repair of orbital fractures and the association of an ocular injury to the severity of facial injury.


METHODS
This was a retrospective cohort study of patients with orbital fractures undergoing operative repair from 2005 to 2013. Subjects were included if they had undergone reconstruction of orbital floor fractures and had data from pre- and postoperative examinations by the oral and maxillofacial surgery and ophthalmology services available. The predictor variables included the service performing the ocular examination (oral and maxillofacial surgery or ophthalmology) and the number of fractures present. The outcome variables were the presence of pre- and postoperative ocular injuries. Logistic regression models were used to determine the relationship of the fracture number to ocular injury.


RESULTS
A total of 28 subjects had undergone repair of orbital fractures with preoperative and postoperative examinations performed by both services. Preoperative ocular injuries were found in 17 of the 28 subjects. Those detected by oral and maxillofacial surgeons were limited to changes in visual acuity, pupillary response, and extraocular muscle dysfunction in 11 subjects. Two subjects had new postoperative ocular findings that were considered minor and did not alter management. An increasing number of facial fractures was associated with an increased risk of ocular trauma. Those with 3 or more fractures had an odds ratio of 14.625 (95% confidence interval, 2.191 to 97.612, P = .006) for the presence of ocular injury.


CONCLUSIONS
Operative repair of orbital fractures did not lead to new ocular injuries that would change the management. Thus, those without preoperative ocular injuries will not require a formal postoperative ophthalmology examination. However, the subjects with more fractures had an increased likelihood of ocular injuries.
Assistant Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: zpeacock@partners.org.
Zachary S
ZS
Peacock
Research Fellow, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
Toufic
T
Boulos
Fellow, Vitreoretinal Ophthalmology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA.
John B
JB
Miller
Assistant Professor and Director, Ophthalmology Emergency Department, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA.
Matthew F
MF
Gardiner
Associate Professor and Director, Predoctoral Education, Harvard School of Dental Medicine, Boston, MA.
Sung-Kiang
SK
Chuang
Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
Maria J
MJ
Troulis
D000328:Adult; D005131:Eye Injuries / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology; D009917:Orbital Fractures / Q000503:physiopathology*; D010808:Physical Examination; D012189:Retrospective Studies