Ophthalmological injuries in isolated orbital fractures: which patients need evaluation?

Orbital fractures are frequently associated with ophthalmological injuries, which range from minor irritation to vision-threatening trauma. This study was intended to identify predictive factors for ophthalmological injuries in patients with isolated orbital fractures, and to assess whether conventional assessment of facial trauma can reliably determine the need for specialist ophthalmological assessment. This prospective cohort study included adult patients with isolated orbital floor and/or medial wall fractures, who underwent standardised ophthalmological evaluation by an ophthalmologist. The outcome variable was the presence of ophthalmological injury. Predictor variables included demographics, injury mechanism, involvement of alcohol, fracture characteristics, and clinical symptoms. Of the 202 patients (206 eyes), 15.3% (31/202 patients) had associated ophthalmological injuries. The most common injuries were retinal haemorrhage (3.0%, six patients), full-thickness eyelid lacerations (2.4%, five patients), and vitreous detachment (2.0%, four patients). Thirteen patients (6.4%) required surgical treatment. No ophthalmological injury was detected in patients who showed no clinical signs or symptoms in the ocular region during the initial conventional facial trauma assessment, which was performed by an oral and maxillofacial surgeon (p<0.001). The results support that asymptomatic patients with isolated orbital fractures may not require a routine ophthalmologist's evaluation. However, patients with clinical signs, such as full-thickness eyelid lacerations, visual disturbances, or abnormal pupillary responses, should be urgently evaluated by an ophthalmologist. Due to the risk of delayed-onset traumatic ocular injuries, orbital fracture patients should be appropriately informed of these eye diseases and increased-risk patients should be followed closely.