Poor prognoses of open globe injuries with concomitant orbital fractures

ABSTRACT

Purpose

Orbital trauma, particularly with open globe injury, can have a wide range of visual outcomes, which can be difficult to predict at presentation. Clinical features on presentation may provide insight into visual prognosis. We hypothesized that patients with open globe injuries and concomitant orbital fractures have poorer visual outcomes than patients without orbital fractures.

Methods

We reviewed the charts of 77 patients with isolated open globe injuries (OG) and 76 patients with open globe injuries and concomitant orbital fractures (OGOF). Multivariate regression analysis was performed to assess the relative influence of individual presenting historical and clinical features on visual outcome.

Results

OGOF patients were more likely to have sustained blunt trauma than a sharp, penetrating injury compared to OG patients. Ocular wound locations were more posterior and likely to involve multiple zones in OGOF compared to OG patients. Among OGOF patients, orbital floor fractures were the most common and roof fractures were the least common, but the latter was associated with presenting NLP vision and multiple zone involvement. The presence of an orbital fracture independently increased the odds of subsequent evisceration/enucleation (OR: 4.6, 95% CI 1.3–20.1, p = .0246) and NLP vision (OR: 6.81, 95% CI 2.42–21.85, p = .0005) when controlling for zone, mechanism of injury, uveal prolapse and demographic variables.

Conclusions

The presence of an orbital fracture independently confers a worse visual and ocular prognosis in patients with open globe injuries. Patients with open globe injuries in this category should be appropriately counseled.

KEYWORDS:

• Eye injury
• eye trauma
• open globe
• open globe injury
• orbital fracture
• orbital roof fracture
• orbital trauma

Disclosure statement

None of the authors have any conflicts of interest relevant to this work. Dr. Eric D. Gaier works as a scientific advisor for Luminopia, a virtual reality company aiming to treat amblyopia. Dr. Gaier is also an inventor on a patented approach to treating amblyopia, which has been licensed to Luminopia (through which MEE and Dr. Gaier are entitled to royalties). All other authors have no financial disclosures.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

Drs. Eric D. Gaier and Seanna Grob received unrestricted research funds from the Society of the Heed Fellows during the time this study was conducted. Dr. Natalie Wolkow received research funds from the Heed Ophthalmic Foundation during the time this study was conducted. The Heed Ophthalmic Foundation and the Society of the Heed Fellows were not involved in directing this work.