Are Orbital Fracture Location, Visual Disturbances, and Head Injury Associated With Severe Ocular and Periocular Injuries? A Retrospective Cohort Study

• Published in: Journal of oral and maxillofacial surgery Vol. 83; no. 6; pp. 700 - 710
• Main Authors: Oliver, David Lopez, Gernandt, Steven, Aymon, Romain, Scolozzi, Paolo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2025
• Subjects: Oral and Maxillofacial Surgery
• ISSN: 0278-2391; 1531-5053; 1531-5053
• DOI: 10.1016/j.joms.2025.03.012

Cranio-maxillofacial fractures involving the orbits are common and may be associated with severe ocular and periocular injuries (OPOIs) requiring prompt management. The purpose of the study was to measure the association between orbital fracture (OF) location, visual disturbances (VDs), head injury (HI), and OPOI severity. A retrospective cohort study was conducted at the University Hospital of Geneva (2008–2021). Inclusion criteria are as follows: subjects ≥18 years with OF due to blunt trauma, who underwent head computed tomography, comprehensive ophthalmological assessment, and had ≥1-year follow-up. Exclusion criteria: subjects <18 years, prior orbital/ophthalmic surgery, penetrating trauma, prior monocular or nonstereoscopic vision, lack of ophthalmological assessment, insufficient clinical data, or follow-up <1 year. Predictors included OFs (categorized by anatomic location), VD (subjective/objective visual acuity decrease or diplopia), and HI, defined as (a) loss of consciousness, (b) Glasgow Coma Scale score, and/or (c) intracranial hemorrhage. The primary outcome was OPOI severity. Severe OPOI was defined as requiring immediate ophthalmic treatment (performed without delay or within 6 hours), while nonsevere OPOI did not require immediate intervention. Covariates included demographic and injury-related parameters. Descriptive, bivariate, and multivariate multinomial logistic regression analyses were performed to identify factors associated with OPOIs. Statistical significance was set at P ≤ .05. The study included 824 patients (mean age: 47.2 ± 23.6 years), the majority of whom were male (n = 580; 70.4%). Adjusted analysis showed severe OPOIs were associated with medial orbital wall fractures (odds ratio [OR], 3.54; 95% CI, 1.78-7.07; P < .01); VD (OR, 3.57; 95% CI, 1.92-6.66; P < .01); HI (OR, 1.99; 95% CI, 1.06-3.74; P = .03) and older age (OR: 1.02; 95% CI: 1.01–1.03; P < .01). Within the limitations of the study, it appears that medial OFs, VD, HI, and older age are associated with severe OPOIs. These findings may help guide early risk assessment and management in patients with OFs.