Chow Jeffrey, Parthasarathi Krishnan, Mehanna Patrick, Whist Eline
Former Registrar, Oral and Maxillofacial Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
Registrar, Oral and Maxillofacial Surgery, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
J Oral Maxillofac Surg. 2018 Nov;76(11):2370-2375. doi: 10.1016/j.joms.2018.04.024. Epub 2018 May 1.
Sight-threatening injuries associated with orbital fractures are of major concern to maxillofacial surgeons whom are often the first asked to assess these patients. Eliciting signs and symptoms that are predictive of these injuries would allow expedited ophthalmic consultation and appropriate management. We hypothesized that abnormal pupillary response is predictive of major ocular injuries.
A retrospective cohort study of patients with facial fractures was instituted with review of all associated ophthalmic injuries. The primary predictor variables were the presence or absence of post-traumatic ocular symptoms and signs (visual acuity change, diplopia, flashes and floaters, pain on globe movement, abnormal pupillary response, restriction of eye movement, and visual field defects). Secondary predictors were pattern of fracture and mechanism of fracture. The primary outcome variable was the presence or absence of major ocular injury assessed during formal ophthalmology consultation. Descriptive statistics were calculated as categorical values. Correlation between the presence or absence of predictors and outcome (major ocular injury) was calculated using χ analysis, with the significance value set at P ≤ .01.
The study included 75 patients (25% of whom were female patients) with a mean age of 41 ± 22 years. We recorded 165 minor ocular injuries and 43 major ocular injuries. The mechanisms of injury included assault (48%, n = 36), motor vehicle accident (21%, n = 16), fall (17%, n = 13), sport (11%, n = 8), and occupational (3%, n = 2). The fracture pattern included zygomaticomaxillary (36%, n = 27), isolated orbital floor (25%, n = 19), complex (20%, n = 15), and isolated orbital nonfloor (19%, n = 14). Of the primary outcome predictors, only abnormal pupillary response (odds ratio, 36; P < .001) and subjective visual acuity changes (odds ratio, 10; P < .001) were predictive of major ocular injury. The mechanism of injury and pattern of fracture were not predictive of major ocular injury.
During primary assessment of the patient with orbital fractures, abnormal pupillary response and subjective visual acuity changes are key predictors of occult major ocular injury.
与眼眶骨折相关的视力威胁性损伤是颌面外科医生主要关注的问题，他们常常是首批被要求评估这些患者的医生。找出可预测这些损伤的体征和症状，将有助于加快眼科会诊及进行适当的处理。我们假设异常瞳孔反应可预测严重眼外伤。
开展一项对面部骨折患者的回顾性队列研究，回顾所有相关的眼科损伤情况。主要预测变量为创伤后眼部症状和体征（视力变化、复视、闪光和飞蚊症、眼球运动时疼痛、异常瞳孔反应、眼球运动受限及视野缺损）的有无。次要预测因素为骨折类型和骨折机制。主要结局变量为在正式眼科会诊期间评估的严重眼外伤的有无。描述性统计以分类值计算。使用χ分析计算预测因素的有无与结局（严重眼外伤）之间的相关性，显著性值设定为P≤0.01。
该研究纳入75例患者（其中25%为女性患者），平均年龄41±22岁。我们记录了165例轻度眼外伤和43例严重眼外伤。损伤机制包括袭击（48%，n = 36）、机动车事故（21%，n = 16）、跌倒（17%，n = 13）、运动（11%，n = 8）和职业伤害（3%，n = 2）。骨折类型包括颧上颌骨骨折（36%，n = 27）、单纯眶底骨折（25%，n = 19）、复杂骨折（20%，n = 15）和单纯眶非底骨折（19%，n = 14）。在主要结局预测因素中，只有异常瞳孔反应（比值比，36；P < 0.001）和主观视力变化（比值比，10；P < 0.001）可预测严重眼外伤。损伤机制和骨折类型不能预测严重眼外伤。
在对眼眶骨折患者进行初步评估时，异常瞳孔反应和主观视力变化是隐匿性严重眼外伤的关键预测因素。
