2017-18 HSC Section 3 Green Book

TABLE I. Types of Ocular Injury.

TABLE III. Incidence of Ocular Injury Associated With Key Physical Exam Findings.

Ocular Injury Type

No.

Ocular Injury Type

No.

No. Subjects

No. Subjects With Ocular Injury (%)

Physical Exam Finding

Posterior Chamber Injury Type

47 Anterior Chamber Injury Type

11

Visual acuity deficits

64

27 (42.2%)

Commotio retinae

16

Hyphema

1 1

Extraocular movements

86 23

28 (32.6%) 17 (73.9%)

Retinal hemorrhage

7

Traumatic iritis

Afferent pupillary defect

Optic neuropathy

11

Traumatic mydriasis

3

Chemosis 6 subconjunctival hemorrhage

114

36 (31.6%)

Retinal detachment

2 2

Corneal abrasion/scar

5 1

Optic nerve avulsion

Iris tear

Optic nerve edema

2

tion between mechanism of injury and ocular injury ( P 5 0.0340), with penetrating trauma being the most likely cause of ocular injury. Four key physical exam findings at the time of pre- sentation were examined and the incidence of ocular injury was assessed. Of the 279 subjects, 114 had chemo- sis 6 subconjunctival hemorrhage, 86 had extraocular movement restriction, 65 had visual acuity deficits, and 23 had afferent papillary defects. The incidence of con- comitant ocular injury was 73.9% (17 of 23) for subjects with an afferent papillary defect, 42.2% (27 of 64) for subjects with visual acuity deficits, 31.6% (36 of 114) for subjects with chemosis 6 subconjunctival hemorrhage, and 32.6% (28 of 86) with extraocular movement restric- tion on physical exam (Table III). More than one abnor- mal physical exam finding was found in 81 subjects, and 35 (43.2%) of these subjects had an associated ocular injury. Using a chi-square analysis, ocular injury was statistically associated with visual acuity deficits and an afferent pupillary defect ( P 5 0.0029 and 0.0001, respec- tively). Chemosis 6 subconjunctival hemorrhage and extraocular movement restrictions were not associated with ocular injury ( P 5 0.2164 and 0.2161, respectively). Maxillofacial CT scans were assessed by two meth- ods to study the incidence of ocular injury based on radi- ographic imaging. Of the 279 subjects in this study, 269 had CT imaging available for review and were included in the anatomic fracture pattern group, and 209 subjects were included in orbital fracture depth group. Table IV describes the association of anatomic fracture patterns with ocular injury. Within this grouping, 41 subjects had a single isolated orbital wall fracture (floor 5 19, medial wall 5 15, lateral wall 5 4, roof 5 3). Isolated single wall orbit fractures had an associated ocular injury of 31.7% (13 of 41). Isolated lateral wall fractures were most commonly associated with ocular injury (2 of 4; 50%). An additional nine subjects had an isolated orbit fracture that involved more than one wall. Interestingly, isolated orbit fractures with multiwall involvement were less likely to have concomitant ocular injury than lateral wall alone (4 of 9; 44.4%). Two hundred twenty-nine sub- jects had an orbit fracture associated with other facial fractures, and 26% of these subjects had concomitant ocular injury (60 of 229). These same 229 subjects were further subcategorized. Fifty-six had ZMC fractures, 40 had nasal/NOE fractures, 13 had frontal bone fractures, and 119 had multiple or panfacial fractures. Concomi- tant ocular injury was observed in 27.5% (11 of 40) of

Retinal pigment

2

epithelial atrophy

Macular hole 1 Orbital apex syndrome 1 foveal lesion 1 Purtscher’s retinopathy 1 Cilioretinal artery occlusion 1 Retrobulbar Hemorrhage 10 Ruptured globe

10

* One subject had both a retrobulbar hematoma and an optic neuropathy.

injuries included posterior segment (n 5 47), retrobulbar hematoma (n 5 10), anterior segment (n 5 11), and rup- tured globe (n 5 10). One of the 77 subjects had both a pos- terior chamber injury and a retrobulbar hematoma, accounting for 78 injuries reported in Table I. The most common posterior segment injury were commotion retinae (n 5 16) and optic neuropathy (n 5 11). The most common anterior segment injuries were corneal abrasion/scar (n 5 5) and traumatic mydriasis (n 5 3). The most common mechanism of injury documented in the patient history causing orbital fracture was motor vehicle accident (n 5 113), followed by blunt trauma (n 5 101), fall (n 5 39), penetrating trauma (n 5 23), and unknown (n 5 3). Concomitant ocular injury was identi- fied in 77 of the 279 subjects (27.5%). Concomitant ocu- lar injury was reported in 39.1% (9 of 23) of the subjects who suffered penetrating trauma, 34.7% (35 of 101) who suffered blunt trauma, 10.3% (4 of 39) who sus- tained a fall injury, 24.8% (28 of 113) who had a motor vehicle accident, and 33.3% (1 of 3) who had an unknown mechanism of injury (Table II). A chi-square analysis demonstrated a statistically significant associa-

TABLE II. Incidence of Ocular Injury Associated With Mechanism of Injury.

No. Subjects With Ocular Injury (%)

Mechanism of Injury (history)

No. Subjects

Motor vehicle accident

113

28 (24.8%)

Blunt trauma

101

35 (34.7%)

Fall

39 23

4 (10.3%) 9 (39.1%)

Penetrating trauma

Unknown

3

1 (33.3%)

279

77

Andrews et al.: Ocular Injury and Orbit Fractures

Laryngoscope 126: February 2016

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