title: Orbit fractures: Identifying patient factors indicating high risk for ocular and periocular injury.
abstract: OBJECTIVE
  Maxillofacial trauma frequently involves the bony orbit that surrounds the ocular globe. Concomitant globe injury is a concern whenever orbit trauma occurs and in severe cases can occasionally result in vision loss. The mechanism of injury, physical exam findings, and radiographic imaging can provide useful information concerning the severity of the injury and concerns for vision loss. Using these three tools, it is hypothesized that the patient's history, physical exam, and radiographic findings can identify high-risk maxillofacial trauma patients with concomitant ocular injury. Identification of high risk patients who require comprehensive ophthalmologic evaluation may alter management and possibly preserve or restore vision.
  
  
  METHODS
  A retrospective clinical chart review was performed at a tertiary academic medical center.
  
  
  METHODS
  Subjects were identified using the institutional trauma registry. Data collected included subject demographics, patient medical records and notes, ophthalmologic testing, and radiographic imaging. The incidence of orbit fracture and concomitant ocular injury associated with the mechanism of injury, physical exam findings, and radiographic imaging was determined. Statistical analysis was performed using a chi-square and Fisher exact test.
  
  
  RESULTS
  In this study, 279 subjects with orbit fractures were identified and the incidence of concomitant ocular injury was 27.6% (77 of 279). Mechanism of injury was statistically associated with an increased risk of ocular injury (P = 0.0340), with penetrating trauma being the most likely etiology. The physical exam findings of visual acuity and an afferent pupillary defect were statistically associated with ocular injury (P = 0.0029 and 0.0001, respectively). Depth of orbit fracture on radiographic imaging was statistically associated with ocular injury (P = 0.0024), with fractures extending to the posterior third of the orbit being most likely to have associated ocular injury.
  
  
  CONCLUSIONS
  Maxillofacial trauma patients with orbit fractures and concomitant ocular injury occur in more than one in four patients. Comprehensive ophthalmologic evaluation is recommended for all patients who sustain an orbit fracture. Subjects with a penetrating trauma mechanism of injury, physical exam findings of visual acuity deficits and an afferent pupillary defect, and radiographic imaging demonstrating fracture depth involvement of the posterior orbit are at highest risk for vision loss and warrant specific concern for ocular injury assessment.
  
  
  METHODS
  IV.
authors.affiliation: Department of Otolaryngology and Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Andrews
authors.affiliation: Department of Otolaryngology and Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.
authors.forename: Anee Sophia
authors.initials: AS
authors.lastname: Jackson
authors.affiliation: Department of Preventative Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.
authors.forename: Niaman
authors.initials: N
authors.lastname: Nazir
authors.affiliation: Department of Ophthalmology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.
authors.forename: Alan
authors.initials: A
authors.lastname: Hromas
authors.affiliation: Department of Ophthalmology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Sokol
authors.affiliation: Department of Otolaryngology and Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.
authors.forename: Todd E
authors.initials: TE
authors.lastname: Thurston
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005131:Eye Injuries / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009917:Orbital Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology*; D014792:Visual Acuity; D014950:Wounds, Penetrating / Q000150:complications / Q000453:epidemiology; D055815:Young Adult
keywords: Orbit fracture; globe injury; ocular injury; orbit trauma; vision loss