11, 16 More recent studies by Richani et al have suggested that pain with eye movements, blurry vision, and motility restriction were predictive of severe ocular injury. 14, 15 Diplopia is one symptom that has long been thought of as an indicator of extraocular muscle entrapment and suggests ocular injury. 10 Ocular symptoms such as blurry vision, pain, and photophobia have been evaluated more recently as predictive factors. 13 The mechanism of injury, specifically penetrating trauma, has also been associated with a greater likelihood of injury. 10, 12 Likewise, complex fractures, including Le Fort II and III fractures, identified on imaging have been noted to increase the risk of ocular injury. 10 Findings on imaging, including the radiographic depth of fracture and location of the fracture, particularly if the fracture extends into the posterior third of the orbit or if it involves the medial wall and orbital floor, can be suggestive of ocular injury. 4, 6, 10, 11 The presence of an afferent pupillary defect (APD) has also been identified as a risk factor for ocular injury. Poor visual acuity (VA) has been frequently cited as a risk factor for ocular injury however, the precise cutoff of poor visual acuity varies from LogMAR VA worse than 0.2 to inability to count fingers. Prior studies have investigated the predictive value of many exam findings. 8, 9 Proper identification of clinical factors predicting underlying severe ocular injury is important in an emergency setting since it can guide management decisions and therefore affect clinical outcome. In general, the occurrence of severe ocular injury and the need for emergent surgery in the setting of orbital fracture is low. For example, some papers define it as any injury with a risk of vision loss, while others list out every diagnosis that falls into the severe category. 3–7 This variability in incidence may be related to differences in the criteria for classifying severe ocular injury. 2 The presence of severe ocular injury in patients with orbital fractures in an emergency setting ranges from 2.7% to 13.7%. 1 The incidence of orbital floor fractures in the US increased by 47%, from 2006 to 2017. From 2001 to 2014, trauma to the orbit accounted for 25% of inpatient admissions due to an ophthalmic disorder in hospitals throughout the United States.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |