Objective

With increasing constraints on our publicly funded health care system, appropriate triage of trauma patients is becoming pivotal, making the primary care assessment (PCA) invaluable. Our study aims to compare the initial assessment of patients with orbital fractures with that conducted by the ophthalmology service.

Design

Retrospective chart review.

Participants

243 patients with 277 fractured orbits presenting to a level 1 trauma centre seen between August 2015 and January 2018.

Methods

Key elements of the PCA, including subjective vision loss, visual acuity, intraocular pressure, pupil examination, and extraocular movements, were documented and compared with the assessment by the ophthalmology service as the control. The primary outcome was inter-rater reliability as estimated by Cohen’s kappa (κ) coefficient. Secondary outcomes included the sensitivity and specificity, as well as the rate of completion of examination components.

Results

PCA examination findings agreed with the ophthalmology service on most components of the examination with the highest agreement with relative afferent pupillary defects and detection of hyphemas (κ = 1). Primary care physicians less often performed most aspects of the assessment. Among performed components of the examination, the average sensitivity was 60.6%, and the average specificity was 84.2%.

Conclusions

Our results show good inter-rater reliability of the PCA compared with the ophthalmology examination but low rate of completion of examination components, suggesting a potential overdependence on the ophthalmology assessment. Given the limited resources of the public health care system, our study may highlight the PCA as a potential focus to improve effective and safe patient management.

https://www.canadianjournalofophthalmology.ca/article/S0008-4182(20)30713-4/fulltext

Although penetrating orbital traumas are rare, they are associated with high rates of mortality and monocular blindness. In addition, they can cause damage to adjacent structures such as the brain, the cavernous sinus, and major arteries. Reported complications include hemorrhage, thrombosis, neurological deficits, facial fractures and associated deformations, and infections.Optimal management of orbital penetrating injuries includes prompt and thorough evaluation and multidisciplinary collaboration between ophthalmology, neurosurgery, trauma surgery, otolaryngology, and radiology.

Here, we present a case of a 68-year-old man who sustained an orbital penetration injury with a 43 cm musical drumstick, which entered the right orbit, displaced the globe, and transited to the left maxillary sinus. Interestingly, the injury spared the globe, optic nerve, brain, and large blood vessels. Swift removal under endoscopic visualization was critical in the successful surgical management of the patient, and the patient’s vision was unaffected. To the best of our knowledge, no reported case of penetrating orbital trauma has involved a foreign body of this length without the occurrence of permanent visual or neurologic sequelae.

https://www.canadianjournalofophthalmology.ca/article/S0008-4182(20)30666-9/fulltext