Significance of subconjunctival hemorrhage in predicting ocular pathology for patients with orbital fracture

Published:March 09, 2022DOI:



      Subconjunctival hemorrhage (SCH) is a common presentation in patients with orbital trauma and often warrants investigation of underlying ocular pathology. Our study aims to assess the significance of SCH severity, graded in a spatial 0–360° manner, as a predictor for ocular pathology in patients with orbital fracture.


      Retrospective chart review.


      Patients with fractured orbits (n = 265) presenting to a level 1 trauma centre between August 2015 and January 2018.


      Key elements of ophthalmic assessment, including visual acuity, SCH (0–360°), anterior- and posterior-segment examination, Hertel exophthalmometry, and ocular pathology, were recorded. Simple logistic regression assessed for association between SCH severity and ocular pathology. Odds ratios (ORs) were calculated with 95% CI.


      Among the 265 fractured orbits, 158 (59.6%) presented with no SCH, and 107 (40.4%) had some degree of SCH. Ocular pathology was noted in 24 fractured orbits (9%). Most common pathologies included entrapment (22.2%), hyphema (16.7%), traumatic optic neuropathy (8.3%), and commotio retinae (8.3%). Simple logistic regression revealed a higher incidence of ocular pathology with increasing severity of SCH from 0–360° (OR = 1.004; 95% CI 1.001–1.007; p = 0.0085). In addition, χ2 analysis demonstrated a higher proportion of ocular pathology in 181–270° (25.0%; p = 0.0466) and 271–360° SCH subgroups (26.3%; p = 0.0031) compared with the 0° SCH subgroup (6.3%).


      Our findings suggest that there is some correlation between the extent of SCH and ocular pathology. However, patient care and investigations should continue to be directed by a full clinical assessment of patients with orbital trauma.
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