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

Published:March 09, 2022DOI:https://doi.org/10.1016/j.jcjo.2022.02.003

      Abstract

      Objective

      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.

      Design

      Retrospective chart review.

      Participants

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

      Methods

      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.

      Results

      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%).

      Conclusions

      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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      References

        • Emodi O
        • Wolff A
        • Srouji H
        • et al.
        Trend and demographic characteristics of maxillofacial fractures in level i trauma center.
        J Craniofac Surg. 2018; 29: 471-475
        • Shin JW
        • Lim JS
        • Yoo G
        • Byeon JH.
        An analysis of pure blowout fractures and associated ocular symptoms.
        J Craniofac Surg. 2013; 24: 703-707
        • Bord SP
        • Linden J.
        Trauma to the globe and orbit.
        Emerg Med Clin North Am. 2008; 26: 97-123
        • Joseph JM
        • Glavas IP.
        Orbital fractures: a review.
        Clin Ophthalmol. 2011; 5: 95-100
        • Santamaria J
        • Mehta A
        • Reed D
        • Blegen H
        • Bishop B
        • Davies B.
        Orbital roof fractures as an indicator for concomitant ocular injury.
        Graefes Arch Clin Exp Ophthalmol. 2019; 257: 2541-2545
        • Kondoff M
        • Nassrallah G
        • Ross M
        • Deschênes J.
        Incidence and outcomes of retrobulbar hematoma diagnosed by computed tomography in cases of orbital fracture.
        Can J Ophthalmol. 2019; 54: 606-610
        • Kreidl KO
        • Kim DY
        • Mansour SE.
        Prevalence of significant intraocular sequelae in blunt orbital trauma.
        Am J Emerg Med. 2003; 21: 525-528
        • Terrill SB
        • You H
        • Eiseman H
        • Rauser ME.
        Review of ocular injuries in patients with orbital wall fractures: a 5-year retrospective analysis.
        Clin Ophthalmol. 2020; 14: 2837-2842
        • Tarlan B
        • Kiratli H.
        Subconjunctival hemorrhage: risk factors and potential indicators.
        Clin Ophthalmol. 2013; 7: 1163-1170
        • Mimura T
        • Yamagami S
        • Usui T
        • et al.
        Location and extent of subconjunctival hemorrhage.
        Ophthalmologica. 2010; 224: 90-95
        • Pokhrel PK
        • Loftus SA.
        Ocular emergencies.
        Am Fam Physician. 2007; 76: 829-836
        • Richani K
        • Do TH
        • Merritt HA
        • Pfeiffer ML
        • Chuang AZ
        • Phillips ME.
        Screening criteria for detecting severe ocular injuries in the setting of orbital fractures.
        Ophthalmic Plast Reconstr Surg. 2019; 35: 609-614
        • Al-Qurainy IA
        • Stassen LF
        • Dutton GN
        • Moos KF
        • el-Attar A
        The characteristics of midfacial fractures and the association with ocular injury: a prospective study.
        Br J Oral Maxillofac Surg. 1991; 29: 291-301
        • Chow J
        • Parthasarathi K
        • Mehanna P
        • Whist E.
        Primary assessment of the patient with orbital fractures should include pupillary response and visual acuity changes to detect occult major ocular injuries.
        J Oral Maxillofac Surg. 2018; 76: 2370-2375
        • Al-Qurainy IA
        • Dutton GN
        • Ilankovan V
        • Titterington DM
        • Moos KF
        El-Attar A. Midfacial fractures and the eye: the development of a system for detecting patients at risk of eye injury: a prospective evaluation.
        Br J Oral Maxillofac Surg. 1991; 29: 368-369
        • Holt GR
        • Holt JE.
        Incidence of eye injuries in facial fractures: an analysis of 727 cases.
        Otolaryngol Head Neck Surg. 1983; 91: 276-279
        • Cook T.
        Ocular and periocular injuries from orbital fractures.
        J Am Coll Surg. 2002; 195: 831-834
        • Jamal BT
        • Pfahler SM
        • Lane KA
        • et al.
        Ophthalmic injuries in patients with zygomaticomaxillary complex fractures requiring surgical repair.
        J Oral Maxillofac Surg. 2009; 67: 986-989
        • He D
        • Blomquist PH
        • Ellis 3rd, E
        Association between ocular injuries and internal orbital fractures.
        J Oral Maxillofac Surg. 2007; 65: 713-720
        • Rajiniganth MG
        • Gupta AK
        • Gupta A
        • Bapuraj JR.
        Traumatic optic neuropathy: visual outcome following combined therapy protocol.
        Arch Otolaryngol Head Neck Surg. 2003; 129: 1203-1206
        • Lee KF
        • Muhd Nor NI
        • Yaakub A
        • Wan Hitam WH
        Traumatic optic neuropathy: a review of 24 patients.
        Int J Ophthalmol. 2010; 3: 175-178
        • McCallum E
        • Keren S
        • Lapira M
        • Norris JH.
        Orbital compartment syndrome: an update with review of the literature.
        Clin Ophthalmol. 2019; 13: 2189-2194
        • Rowh AD
        • Ufberg JW
        • Chan TC
        • Vilke GM
        • Harrigan RA.
        Lateral canthotomy and cantholysis: emergency management of orbital compartment syndrome.
        J Emerg Med. 2015; 48: 325-330
        • Kim YS
        • Kim JH
        • Hwang K.
        The frequency of decreased visual acuity in orbital fractures.
        J Craniofac Surg. 2015; 26: 1581-1583
        • Yeatts RP.
        Measurement of globe position in complex orbital fractures: II. Patient evaluation utilizing a modified exophthalmometer.
        Ophthalmic Plast Reconstr Surg. 1992; 8: 119-125
        • Jank S
        • Schuchter B
        • Emshoff R
        • et al.
        Clinical signs of orbital wall fractures as a function of anatomic location.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 96: 149-153