title: Assessment of Emergency Department Eye Examinations in Patients Presenting with Mid-Face Injury.
abstract: BACKGROUND
  One-fifth of patients with severe facial trauma suffer ophthalmic injury. Currently, patients presenting with mid-face injury to the emergency department (ED) undergo visual examination and then further assessment by ophthalmologists and with computed tomography (CT) scanning. The utility of the initial visual examination in the ED, performed by nonophthalmologists, remains unclear.
  
  
  OBJECTIVE
  We aimed to objectively identify whether a more thorough initial visual assessment, performed by nonophthalmologists in the ED, was associated with improved ophthalmic outcomes.
  
  
  METHODS
  Patients (n = 100) were retrospectively recruited from a tertiary craniomaxillofacial center. Visual examinations performed in the ED were scored objectively and measured against defined management and prognostic outcomes.
  
  
  RESULTS
  There was no significant difference between more thorough initial visual examination and reduced time to ophthalmology assessment or reduced visual complications. There was no correlation between more comprehensive examination and incidence of CT scanning.
  
  
  CONCLUSIONS
  We identified no significant difference between a comprehensive visual examination performed by nonophthalmologists in the ED, and improved ophthalmic outcomes. Physicians assessing patients with mid-face trauma in the ED should rule out eye emergencies, including retrobulbar hemorrhage and penetrating globe injury, and initiate expeditious CT scan and assessment by specialist ophthalmologists.
authors.affiliation: Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK.
authors.forename: Ted
authors.initials: T
authors.lastname: Welman
authors.affiliation: Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK.
authors.forename: Kumaran
authors.initials: K
authors.lastname: Shanmugarajah
authors.affiliation: Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK.
authors.forename: Shiraz
authors.initials: S
authors.lastname: Sabah
authors.affiliation: Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Bryan
authors.affiliation: Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK.
authors.forename: Nadine
authors.initials: N
authors.lastname: Hachach-Haram
authors.affiliation: Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Segaren
authors.affiliation: Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Collier
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005131:Eye Injuries / Q000175:diagnosis* / Q000209:etiology; D005151:Facial Injuries / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000592:standards*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D015599:Trauma Severity Indices
keywords: eye examination; facial trauma; mid-face injury; ophthalmology assessment; visual complications