Where Should We Focus in Emergency Orbital Trauma?

Year 2023, Volume: 5 Issue: 3, 608 - 12, 18.09.2023

Abdullah Şükün , Elmas Yüksel Şükün

https://doi.org/10.37990/medr.1309554

Abstract

Aim: To describe the most common findings in orbital trauma and to support radiologic decision making by comparing them in 7 pathology regions.
Material and Methods: A total of 190 patients (119 males and 71 females) participated in the study. Orbital injury pathologies were documented and compared in seven regions. The most typical results of orbital tomography were determined. Binominal regression analysis was also performed for each trauma region.
Results: 190 orbital CT scans showed 13.7% orbital bone fractures (n=26), 7.9% bulbus pathology (n=15), 2.6% vitreous pathology (n=5), 2.1% extraocular muscle pathology (n=4), and 6.3% (n=13) retrobulbar pathology. The most common globe pathologies were lens displacement and globe rupture. Retrobulbar fat plane changes (4.2% n=8) were the most common pathology in the region. Periorbital edema was the most common periorbital disease in 86.3% of cases (n=164). When evaluated using cross-tabulations between the seven pathologic regions, the relationship between bone pathology and retrobulbar area and between globe and vitreous was statistically significant (p<0.05). In binominal regression analyses, 5 trauma models were significant and showed more than 80 percent success in predicting trauma location (p<0.05).
Conclusion: Orbital fractures and pathologies of the retrobulbar space, globe and vitreous are interrelated. Radiologists should be familiar with orbital fracture patterns, potential soft tissue injuries and ocular anomalies and should be able to evaluate the relationship between pathologies.

Keywords

orbital traumas, orbital tomography, computed tomography, prevalence

References

• 1. Lee HJ, Jilani M, Frohman L, Baker S. CT of orbital trauma. Emerg Radiol. 2004;10:168-72.
• 2. Gad K, Singman EL, Nadgir RN, et al. CT in the evaluation of acute injuries of the anterior eye segment. AJR Am J Roentgenol. 2017;209:1353-9.
• 3. Ojaghihaghighi S, Lombardi KM, Davis S, et al. Diagnosis of traumatic eye injuries with point-of-care ocular ultrasonography in the emergency department. Ann Emerg Med. 2019;74:365-71.
• 4. Carlberg DJ, Izzo MC, Davis JE. Middle aged male with blurry vision following blunt orbital trauma. J Am Coll Emerg Physicians Open. 2020;1:1736-7.
• 5. Erickson BP, Garcia GA. Evidence-based algorithm for the management of acute traumatic retrobulbar haemorrhage. Br J Oral Maxillofac Surg. 2020;58:1091-6.
• 6. Gordon AA, Tran LT, Phelps PO. Eyelid and orbital trauma for the primary care physician. Dis Mon. 2020;66:101045.
• 7. Ray CN, Marsh HD, Gilmore JE, et al. Review of 451 patients presenting with orbital wall fractures: a retrospective analysis. J Craniofac Surg. 2023;34:126-30.
• 8. Park RB, North VS, Rebhun CL, et al. Globe compression by bone fragments in orbital blow-in fractures: a case series and systematic review. Ophthalmic Plast Reconstr Surg. 2023;39:162-9.
• 9. Priore P, Di Giorgio D, Marchese G, et al. Orbital bone fractures: 10 years' experience at the Rome trauma centre: retrospective analysis of 543 patients. Br J Oral Maxillofac Surg. 2022;60:1368-72.
• 10. Koenen L, Waseem M. Orbital Floor Fracture. https://www.ncbi.nlm.nih.gov/books/NBK534825/ accessed date 25.09.2022
• 11. Eng JF, Younes S, Crovetti BR, Williams KJ, Haskins AD, Hernandez DJ et al. Characteristics of orbital injuries associated with maxillofacial trauma. laryngoscope. 2023;133:1624-9.
• 12. Alsaleh F, Dhillon J, Nassrallah EIB, et al. Clinical correlations of extraocular motility limitation pattern in orbital fracture cases: a retrospective cohort study in a level 1 trauma centre. Orbit. 2022:1-9.
• 13. Pontell ME, Jackson K, Golinko M, Drolet BC. Influence of radiographic soft tissue findings on clinical entrapment in patients with orbital fractures. J Craniofac Surg. 2021;32:1427-31.
• 14. Moffatt J, Hughes D, Bhatti N, Holmes S. Orbital bone fractures in a central london trauma center: a retrospective study of 582 patients. J Craniofac Surg. 2021;32:1334-7.
• 15. 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;14:2837-42.
• 16. Arabi A, Shahraki T, Nezam-Slami R, et al. Axial or coronal CT scan; which is more accurate in detection of open globe injury? Injury. 2021;52:2611-5.
• 17. Chen A, Canner JK, Zafar S, et al. Characteristics of ophthalmic trauma in fall-related hospitalizations in the United States from 2000 to 2017. Ophthalmic Epidemiol. 2022;29:206-15.
• 18. Cellina M, Ce M, Marziali S, et al. Computed tomography in traumatic orbital emergencies: a pictorial essay-imaging findings, tips, and report flowchart. Insights Imaging. 2022;13:4.