Zhong Eric, Chou Timothy Y, Chaleff Alec J, Scofield-Kaplan Stacy M, Perzia Brittany M, Naqvi Jaffer, Hou Wei
Department of Ophthalmology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
Department of Epidemiology and Biostatistics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
Clin Ophthalmol. 2022 Dec 14;16:4153-4161. doi: 10.2147/OPTH.S391175. eCollection 2022.
To identify factors predictive of serious ocular injury requiring urgent consultation by ophthalmology in patients presenting with blunt trauma orbital fractures.
This is a retrospective study of adult patients diagnosed with orbital fractures after blunt trauma at a university medical center emergency room. Patient records were examined over a three-year period. Data including mechanism of injury, fracture location, ocular symptoms, and examination findings were recorded. Ocular injuries were divided into three levels of severity: mild, moderate, and severe. Fracture characteristics, patient demographics, and examination findings were analyzed using multinomial regression to identify risk factors for more severe injury.
One hundred and eighty-six patients met inclusion criteria. For 29.6% of patients, urgent ophthalmologic consultation was required. Ruptured globes occurred in 2.2% of injuries. There was a statistically significant association between severe ocular injury and three examination findings: poor vision (OR 14.5; p < 0.001), afferent pupillary defect (OR 44.8; p < 0.001), and abnormal pupillary reaction (OR 28.0; p < 0.001). Likewise, blurry vision (OR 3.6; p = 0.018), ocular pain (OR 3.7; p = 0.011), and facial pain (OR 4.4; p = 0.031) were also associated with an increased risk of severe ocular injury. Abnormal pupillary reaction was associated with moderate injury (OR 4.5; p = 0.041). Demographic factors, mechanism of injury, anti-coagulant use, fracture location, diplopia, no documented vision, subconjunctival hemorrhage, chemosis, and motility restriction were not associated with injury severity.
Most patients who presented to the emergency room with an orbital fracture did not require urgent ophthalmologic consultation. The presence of blurry vision, ocular pain, facial pain, poor vision, and afferent pupillary defect significantly increased the odds of severe injury. Abnormal pupillary reaction was associated with both moderate and severe injury.
确定钝性眼眶骨折患者中需要眼科紧急会诊的严重眼外伤的预测因素。
这是一项对在大学医学中心急诊室诊断为钝性外伤后眼眶骨折的成年患者的回顾性研究。对患者记录进行了为期三年的检查。记录了包括受伤机制、骨折部位、眼部症状和检查结果等数据。眼外伤分为轻度、中度和重度三个严重程度级别。使用多项回归分析骨折特征、患者人口统计学和检查结果，以确定更严重损伤的危险因素。
186名患者符合纳入标准。29.6%的患者需要紧急眼科会诊。2.2%的损伤发生眼球破裂。严重眼外伤与三项检查结果之间存在统计学显著关联：视力差（比值比14.5；p<0.001）、传入性瞳孔障碍（比值比44.8；p<0.001）和异常瞳孔反应（比值比28.0；p<0.001）。同样，视力模糊（比值比3.6；p = 0.018）、眼痛（比值比3.7；p = 0.011）和面部疼痛（比值比4.4；p = 0.031）也与严重眼外伤风险增加相关。异常瞳孔反应与中度损伤相关（比值比4.5；p = 0.041）。人口统计学因素、受伤机制、抗凝剂使用、骨折部位、复视、无视力记录、结膜下出血、球结膜水肿和眼球运动受限与损伤严重程度无关。
大多数因眼眶骨折就诊于急诊室的患者不需要紧急眼科会诊。视力模糊、眼痛、面部疼痛、视力差和传入性瞳孔障碍的存在显著增加了严重损伤的几率。异常瞳孔反应与中度和重度损伤均相关。
