Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON.
Department of Ophthalmology, University of Ottawa, Ottawa, ON.
Can J Ophthalmol. 2024 Jun;59(3):187-193. doi: 10.1016/j.jcjo.2023.03.007. Epub 2023 Mar 28.
To estimate the incidence of ophthalmologic pathology at presentation of patients with orbital fracture to a level I trauma centre and the most significant associated risk factors.
A total of 244 patients with 278 fractured orbits over a 2-year period at a level I trauma centre were reviewed. The primary outcome was the incidence of urgent ophthalmologic pathology, defined as requiring attention without delay. Patient demographics, history, findings on radiographic imaging, and physical examination findings at initial and follow-up examinations were recorded. Odds ratios with 95% confidence intervals were calculated.
On initial examination and follow-up, 9.7% of orbits had ophthalmologic pathology. Only 3 patients (1.1%) had urgent pathology, including orbital compartment syndrome and globe rupture, whereas 22 patients (7.9%) had semiurgent pathology and 4 patients (1.4%) had nonurgent pathology. Subjective decreased vision (odds ratio [OR] = 3.5; p = 0.021), assault-related injuries (OR = 2.4; p = 0.036), work-related injuries (OR = 7.7; p = 0.004), afferent pupillary defect (OR = 19.2; p = 0.017), anisocoria (OR = 7.8; p = 0.001), and symmetrical extraocular movement limitation (OR = 5.2; p = 0.003) and fixed pupil (OR = 16.9; p < 0.001) had statistically significant odds ratios associated with pathology. Patient sex, eye involved, intoxication, anticoagulation, and antiplatelets, as well as previous ocular surgery, were not associated with pathology.
Most orbital fractures do not present with ophthalmologic pathology. Subjective vision loss, history of assault or work trauma, and pupil abnormalities on examination were the greatest risk factors for pathology. Our results highlight the most important factors on patient presentation that should prompt first responders to seek urgent ophthalmologic consultation.
评估在一级创伤中心就诊的眶骨骨折患者的眼部病变发生率及最重要的相关危险因素。
回顾了 2 年内在一级创伤中心就诊的 244 例 278 例眶骨骨折患者的资料。主要结局为需要立即关注的紧急眼科病变发生率。记录患者的人口统计学、病史、影像学检查结果和初始及随访检查的体格检查结果。计算比值比及其 95%置信区间。
在初次检查和随访时，9.7%的眼眶存在眼部病变。仅有 3 例（1.1%）患者存在紧急病变，包括眶隔综合征和眼球破裂，而 22 例（7.9%）患者存在半紧急病变，4 例（1.4%）患者存在非紧急病变。主观视力下降（比值比[OR] = 3.5；p = 0.021）、与外伤相关的损伤（OR = 2.4；p = 0.036）、工作相关的损伤（OR = 7.7；p = 0.004）、传入性瞳孔缺陷（OR = 19.2；p = 0.017）、瞳孔不等大（OR = 7.8；p = 0.001）和对称性眼球运动受限（OR = 5.2；p = 0.003）以及固定瞳孔（OR = 16.9；p < 0.001）与病变具有统计学显著的比值比。患者性别、受伤眼别、中毒、抗凝和抗血小板治疗以及既往眼部手术均与病变无关。
大多数眶骨骨折患者并不伴有眼部病变。主观视力下降、外伤或工作外伤史以及检查时的瞳孔异常是病变的最大危险因素。我们的结果突出了患者就诊时最重要的因素，这些因素应促使急救人员寻求紧急眼科会诊。
