Radiological findings of orbital blowout fractures: a review

26 Mar 2021

Ma ReginaPaula Valencia, Hidetaka Miyazaki, Makoto Ito, Kunihiro Nishimura, Hirohiko Kakizaki & Yasuhiro Takahashi

Journal : Orbit

Ref : Orbit Orbital emphysema Orbital fracture

Factors Associated With Increased Risk of Serious Ocular Injury in the Setting of Orbital Fracture

15 Jan 2021

Elizabeth J. Rossin, MD, PhD1; Colleen Szypko, BS1; Isaiah Giese, MD2; Nathan Hall, MS1; Matthew F. Gardiner, MD1; Alice Lorch, MD, MPH1

Importance Orbital fractures are common in ocular trauma, and there is a need to develop predictive tools to estimate risk of concurrent ocular injury.

Objective To identify clinical and radiographic features that are associated with increased risk of substantial ocular injury in the setting of orbital fracture.

Design, Setting, and Participants Retrospective consecutive case series of patients who sustained orbital fractures between 2012 and 2018. Examinations were done at 1 of 2 level 1 trauma centers in the emergency or inpatient setting. A total of 430 consecutive patients (500 eyes) between 2012 and 2017 met inclusion criteria for the training sample. After building a predictive model, 88 additional consecutive patients (97 eyes) between 2017 and 2018 who met inclusion criteria were collected as a test sample.

Main Outcomes and Measures The primary outcome measure was substantial ocular injury distinct from orbital fracture.

Results The mean age of our patient population was 53.5 years (range, 16-100 years). The overall rate of substantial ocular injury was 20.4%, and the rate of injury requiring immediate ophthalmic attention was 14.4%. Five variables were found to be associated with increased risk of substantial ocular injury: blunt trauma with a foreign object (odds ratio [OR], 19.4; 95% CI, 6.3-64.1; P < .001), inability to count fingers (OR, 10.1; 95% CI, 2.8-41.1; P = .002), roof fracture (OR, 9.1; 95% CI, 2.8-30.0; P = .002), diplopia on primary gaze (OR, 6.7; 95% CI, 1.7-25.1; P = .003), and conjunctival hemorrhage or chemosis (OR, 4.2; 95% CI, 2.2-8.5; P < .001). The results were translated into a bedside tool that was tested in an independent group of eyes (n = 97) and found to be associated with substantial ocular injury with a 95% sensitivity (95% CI, 77.2-99.9), 40% specificity (95% CI, 28.9-52.0), 31.8% positive predictive value (95% CI, 27.5-36.5), and 96.8% negative predictive value (95% CI, 81.3-99.5).

Conclusions and Relevance A minority of patients with an orbital fracture had a substantial ocular injury. Certain radiographic and clinical findings were associated with substantial ocular injury. Testing of the algorithm in prospective longitudinal settings appears warranted.

https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2773333

INVITED COMMENTARY:

David C. Herman, MD1

Who should receive emergency assessment for serious ocular injury by an ophthalmologist in the setting of orbital fracture? This question is important on a variety of levels. The first and foremost is the care of the patient. Often, the physician to first assess the patient may have neither the expertise nor the equipment to perform the type of examination required to diagnose or rule out a sight-threatening ocular injury. Given that premise, all patients could reasonably be referred for a more detailed examination by an ophthalmologist.

https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2773330

Journal : JAMA Ophthal

Ref : Ocular injury Orbit Orbital fracture Orbital trauma

Utilizing 3D-Printed Orbital Floor Stamps to Create Patient-Specific Implants for Orbital Floor Reconstruction

2 Jan 2021

Prabhu, Shamit S.; Chung, Scotty A.; Brown, Philip J.; Runyan, Christopher M.

Journal : OPRS

Ref : 3D printing Orbit Orbital fracture

Isolated abducens nerve palsy following temporal bone fracture in a child

30 Oct 2020

Vibha Baldev, Shailja Tibrewal, Soveeta Rath, Suma Ganesh

Journal : Taiwan J Oph

Ref : Abducens nerve paresis Orbit Orbital fracture Orbital trauma

Poor prognoses of open globe injuries with concomitant orbital fractures

14 Jul 2020

Eric D. Gaier , Sami Tarabishy , Christopher Bayers , Natalie Wolkow , Matthew Gardiner , Daniel R. Lefebvre & Seanna Grob

Journal : Orbit

Ref : Open globe injury Orbit Orbital fracture Orbital trauma

Precision in Oculofacial Surgery: Made-To-Specification Cast-Molded Implants in Orbital Reconstruction

27 Jun 2020

Chen, Allison J.; Chung, Natalie N.; Liu, Catherine Y.; MacIntosh, Peter W.; Korn, Bobby S.; Kikkawa, Don O.

Journal : OPRS

Ref : Orbit Orbital fracture Orbital fracture repair Orbital trauma Preformed orbital implant

Anomalous orbital structure mimicking fracture of orbital floor

6 Jun 2020

Vibha Baldev, Shailja Tibrewal

Journal : JAAPOS

Ref : Enophthalmos Orbit Orbital fracture

Prediction of late displacement of the globe in orbital blowout fractures

20 Mar 2020

Yongrong Ji, Yixiong Zhou, Qin Shen, Wei Xu, Shengfang Ge, Lixu Gu, Xianqun Fan

Purpose

To establish a linear measuring method in computed tomographic (CT) images to predict the displacement of the globe late after orbital blowout fracture.

Methods

Subjects were retrospectively included. Inclusion criteria were as follows: (1) adult subjects (≥18 years old at the time of trauma); (2) unilateral orbital medial‐wall and/or floor fractures; (3) CT examination at least 30 days after trauma. Exclusion criteria were as follows: (1) facial or orbital fracture extending to other parts of the orbit than medial‐wall and/or floor; (2) history of orbital or ocular abnormality other than the orbital trauma; (3) severe ocular trauma accompanied by the orbital trauma; (4) orbital fracture treated surgically before the CT examination. A co‐ordinate system was built based on the orbital CT scans. Displacements of orbital walls, displacement of the globe and relative location of the fracture site were measured. Correlations between the variables were investigated.

Results

Ninety‐nine per cent of fracture sites of the medial wall and 100% of fracture sites of the floor were posterior to the centre of the unaffected globe. The affected globe moved significantly medially (p < 0.001) and backwards (p < 0.001) in pure medial‐wall fracture; backwards (p < 0.001) and downwards (p = 0.017) in pure floor fracture; and medially (p < 0.001), backwards (p < 0.001) and downwards (p < 0.001) in medial‐wall and floor fractures. Displacement of the globe was correlated with displacements of the orbital walls, and the regression formulae were therefore fitted. Application of the formulae revealed that the same extent of orbital wall displacement caused more displacement of the globe in female patients than in male patients.

Conclusions

A linear measuring method in a three‐dimensional co‐ordinate system was established to identify the displacements of orbital walls and the displacement of the globe in orbital blowout fractures. The regression formulae generated in this study might be used in clinical practice to predict late displacement of the globe by measuring the displacements of orbital walls.

https://onlinelibrary.wiley.com/doi/10.1111/aos.14226

Journal : Acta Ophthalmologica

Ref : Enophthalmos Orbit Orbital floor fracture Orbital fracture Orbital trauma

Orbital Injuries From Self-Inflicted Gunshots: Patterns, Management, and Visual Outcomes

17 Mar 2020

Elegbede, Adekunle; Drogt, Carolyn; Wasicek, Philip J.; Dunlow, Ryan; Gebran, Selim; Ngaage, Ledibabari M.; Rasko, Yvonne M.; Liang, Fan; Nam, Arthur J.; Grant, Michael P.

Purpose:

Self-inflicted facial gunshots (SIGSWs) typically result in a spectrum of severe injuries to facial structures, including the orbit and globe. Roughly three-quarters of those who arrive to the hospital will survive their injuries, and recidivism is typically low. Therefore, effective management is paramount to preserve vision, and long-term quality of life. The objective of this study is to characterize the common injuries to the orbit, globe, and periocular structures following SIGSWs, their management, and their eventual visual and reconstructive outcomes.

Methods:

Retrospective review of trauma registry records at a Level 1 trauma center for patients who presented alive following SIGSWs involving the globe and/or orbit from 2007 to 2016.

Results:

Of the 47 patients who presented with SIGSWs to the orbit, 33 (70%) were discharged alive from the hospital. Management strategies for these patients fell into 3 groups, based on the involved structures: i) Open globe injuries (Type I: n = 12, 34%) ii) Orbital fractures with preserved globe and optic nerve (Type II: n = 15, 43%), and iii) Optic nerve injuries with preserved globe (Type III: n = 8, 23%). Compared with Type II and III injuries, patients who had Type I injuries were more likely to die prior to hospital discharge (46% vs. 20% vs. 12%, p = 0.04), undergo ophthalmologic intervention (73% vs. 6% vs. 11%, p = 0.01), and more surgery (6 vs. 3 vs. 0.5 mean surgeries, p < 0.001). Type II injuries most frequently underwent debridement and reconstruction of the bony orbit. Type III and Type I injuries were associated with worse initial and final visual acuity, with the majority (100% and 75%, respectively) having No Light Perception (NLP) on initial exam, and no visual recovery during the follow-up period (median follow up= 25 months).

Conclusions:

Management and visual outcomes of orbital injuries from SIGSWs is determined by whether the globe and optic nerve are preserved. Open globe injury by itself is associated with higher mortality and significant permanent vision loss.

https://journals.lww.com/op-rs/Abstract/2020/03000/Orbital_Injuries_From_Self_Inflicted_Gunshots_.10.aspx

Journal : OPRS

Ref : Orbit Orbital fracture Orbital trauma

Orbital Fractures and Associated Ocular Injuries in Operation Iraqi Freedom and Operation Enduring Freedom Referred to a Tertiary Care Military Hospital and the Effect on Final Visual Acuity

26 Jan 2020

Justin, Grant A.; Turnage, Winston A.; Brooks, Daniel I.; Davies, Brett W.; Ryan, Denise S.; Eiseman, Andrew S.; Weichel, Eric D.; Colyer, Marcus H.

Purpose:

To update the incidence of orbital fractures in U.S. Soldiers admitted to the former Walter Reed Army Medical Center from 2001 to 2011 after sustaining combat injuries in Operation Iraqi Freedom and Operation Enduring Freedom.

Methods:

Data were collected in the Walter Reed Ocular Trauma Database. Inclusion criteria were any U.S. Soldier or Department of Defense civilian with an orbital fracture injured in Operation Iraqi Freedom/Operation Enduring Freedom. Primary outcome measures were final visual acuity and the effect of orbital fracture, number of fractures, and anatomic location of fracture on final visual acuity.

Results:

Eight-hundred ninety eye injuries occurred in 652 patients evacuated to Walter Reed Army Medical Center between 2001 and 2011. Orbital fractures occurred in 304 eyes (34.2%). A single wall was fractured in 140 eyes (46.05%), 2 in 99 (32.6%) eyes, 3 in 31 (10.2%), 4 in 28 (9.2%), and unknown in 6 (1.9%) eyes. Roof fractures were found in 74 (24.34%), medial wall in 135 (44.41%), lateral wall in 109 (35.9%), and floor fractures in 217 (71.4%). Final visual acuity was analyzed and 140 (46.05%) eyes had greater than 20/40 vision, 17 (5.59%) were 20/50 to 20/200, 26 (8.5%) were count fingers to light perception, and 95 (31.3%) were no light perception. In logistic regression analysis, roof (p = 0.001), medial (p = 0.009), and lateral fractures (p = 0.016) were significantly associated with final visual acuity less than 20/200, while floor fractures were not (p = 0.874). Orbital fracture and all fracture subtypes were significantly associated with traumatic brain injury, retrobulbar hematoma, optic nerve injury, but not for vitreous hemorrhage, commotio, hyphema, and choroidal rupture. Fracture repair was noted in 45 (14.8%).

Conclusions:

Orbital fractures occurred in a third of Operation Iraqi Freedom/Operation Enduring Freedom eyes of ocular trauma patients referred to one tertiary care military hospital. This resulted in approximately 40% of these eyes remaining legally blind after injury.

Orbital fractures occur commonly during combat trauma and a significant number are legally blind despite appropriate treatment.

https://journals.lww.com/op-rs/Abstract/2020/01000/Orbital_Fractures_and_Associated_Ocular_Injuries.13.aspx

Journal : OPRS

Ref : Orbit Orbital fracture

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