Terrill Stephanie B, You Hyelin, Eiseman Heidi, Rauser Michael E
Department of Ophthalmology, Loma Linda University Eye Institute, Loma Linda, CA, USA.
Department of Ophthalmology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Clin Ophthalmol. 2020 Sep 24;14:2837-2842. doi: 10.2147/OPTH.S274567. eCollection 2020.
The purpose of this study was to determine the incidence of minor and major ocular injuries in patients with orbital wall fractures at Loma Linda University Health, a level-one trauma center, to help determine the most appropriate setting for the initial dilated fundus examination by ophthalmologists.
A retrospective study was performed from January 2008 to January 2013 of patients diagnosed with orbital wall fracture secondary to trauma. Exclusion criteria included unknown mechanism of injury, the absence of ophthalmology consultation, or absence of imaging. Data collected included age, gender, mechanism of injury, visual acuity, and anterior/posterior segment findings. Ocular injuries were categorized as either minor or major.
Of 567 charts reviewed, 460 met criteria and were included for analysis. In the analysis, 86.5% of patients were male, and 81.3% were Caucasian. The most common mechanism of orbital fracture was blunt injury. Visual acuity was better than 20/100 in 82.4% of patients. On chart review, 81.1% of patients were found to have either a minor injury, a major injury, or both. The most common injury was subconjunctival hemorrhage (53.5%). Globe rupture (2.9%) and vision-threatening posterior segment findings such as retinal tear and choroidal rupture (1.3%) were relatively rare. Only one retinal detachment (0.2%) was found, specifically in the setting of severe injury with concomitant globe rupture.
Knowledge of the common ocular injuries associated with orbital fractures will help emergency department (ED) physicians and ophthalmologists provide the dilated fundus exam in the most appropriate setting. The most frequent injuries identified were non-vision threatening, and visually significant posterior segment findings were relatively rare (1.3%). Thus, for the majority of patients presenting to the ED with orbital fracture, a dilated fundus exam can be performed at a later date in the outpatient clinic setting, unless urgent orbital fracture surgery is planned.
本研究旨在确定洛马林达大学医学中心（一级创伤中心）眼眶壁骨折患者中轻度和重度眼外伤的发生率，以帮助确定眼科医生进行初次散瞳眼底检查的最合适时机。
对2008年1月至2013年1月诊断为创伤性眼眶壁骨折的患者进行回顾性研究。排除标准包括损伤机制不明、未进行眼科会诊或无影像学检查。收集的数据包括年龄、性别、损伤机制、视力以及眼前段/眼后段检查结果。眼外伤分为轻度或重度。
在审查的567份病历中，460份符合标准并纳入分析。分析显示，86.5%的患者为男性，81.3%为白种人。眼眶骨折最常见的机制是钝器伤。82.4%的患者视力优于20/100。经病历审查，81.1%的患者被发现有轻度损伤、重度损伤或两者皆有。最常见的损伤是结膜下出血（53.5%）。眼球破裂（2.9%）以及威胁视力的眼后段检查结果，如视网膜裂孔和脉络膜破裂（1.3%）相对少见。仅发现1例视网膜脱离（0.2%），具体发生在伴有眼球破裂的严重损伤情况下。
了解与眼眶骨折相关的常见眼外伤情况将有助于急诊科医生和眼科医生在最合适的时机进行散瞳眼底检查。所发现的最常见损伤不威胁视力，而具有视觉意义的眼后段检查结果相对少见（1.3%）。因此，对于大多数因眼眶骨折就诊于急诊科的患者，除非计划进行紧急眼眶骨折手术，否则可在门诊较晚时间进行散瞳眼底检查。
