Patterns and prognosis of commotio retinae in orbital wall fractures.

PURPOSE

Orbital wall fractures are a significant cause of ocular injury in trauma and are associated with posterior segment pathology. This study aims to characterize patterns and prognosis of commotio retinae following orbital wall fracture.

METHODS

This study is a retrospective analysis of 294 orbital wall fractures diagnosed by computed tomography imaging from August 2015 to October 2016 at a Level 1 trauma center. Dilated funduscopic exams were assessed for acute posterior segment pathology, focusing specifically on commotio retinae ( = 38). These were compared with patients with no traumatic retinal findings ( = 253) to indicate statistically significant differences in the mechanism of injury, fracture pattern, subjective symptoms, radiologic and exam findings, and acute interventions.

RESULTS

Commotio was most commonly associated with assault (60.5%,  = 0.004) in a younger patient population, whereas normal retinal exams were more likely after falls from standing (24.1%,  = 0.022). Half of all commotio was found inferiorly and most commonly occurred in medial or inferior wall fracture. Patients with commotio were more likely to have motility deficits (29.7%,  = 0.049) with clinical evidence of entrapment (13.2%,  < 0.001), requiring acute operative repair (15.8%,  = 0.005). Inferior wall fracture was associated with 19.4% surgical intervention in commotio as compared with those with normal funduscopic exams (6.1%,  = 0.012). All patients with follow-up had resolution of commotio and best-corrected visual acuity of 20/25 or better.

CONCLUSION

Retinal pathology is not infrequent in orbital wall fractures. Inferior wall fracture was associated with 19.4% surgical intervention in commotio as compared to those with normal funduscopic exams (6.1%,  = 0.012). A high index of suspicion and thorough investigation is warranted in evaluating these patients.