Analysis of Ocular Complications and Blowout Fracture in Orbital Blunt Trauma

Jae Wan Lim; Jae Ho Yoo; Ki Yup Nam; Seung Uk Lee; Sang Joon Lee

doi:10.3341/jkos.2016.57.8.1282

Journal List > J Korean Ophthalmol Soc > v.57(8) > 1010371

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Lim, Yoo, Nam, Lee, and Lee: Analysis of Ocular Complications and Blowout Fracture in Orbital Blunt Trauma

Original Article

J Korean Ophthalmol Soc 2016;57(8):1282-1286.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.8.1282

Analysis of Ocular Complications and Blowout Fracture in Orbital Blunt Trauma

Jae Wan Lim, MD, Jae Ho Yoo, MD, Ki Yup Nam, MD, PhD, Seung Uk Lee, MD, PhD, Sang Joon Lee, MD, PhD

Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea

Address reprint requests to Sang Joon Lee, MD, PhD Department of Ophthalmology, Kosin University Gospel Hospital, #262 Gamcheon-ro, Seo-gu, Busan 49267, Korea Tel: 82-51-990-6140, Fax: 82-51-990-3026 E-mail: hhiatus@gmail.com

Received 11 February 2016 Revised 14 April 2016 Accepted 16 June 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To help predict the severity of ocular complications in orbital blunt trauma by analyzing clinical features of ocular complications and orbital wall fracture.

Methods

A retrospective survey consisting of 169 eyes of 168 patients with orbital blunt trauma who visited Kosin University Gospel Hospital was performed. The patients' age, gender, height, weight, cause of accident, and ocular complications were investigated. The patients were imaged using computer tomography and divided into two groups according to whether they had orbital wall fracture: the orbital contusion group and the orbital wall fracture group. Variables of orbital wall fracture, including the location, length, width, and area were measured using computer tomography in the orbital wall fracture group.

Results

The incidence of ocular complication was 27 of 67 eyes (40.2%) in the orbital wall fracture group and 75 of 102 eyes (73.5%) in the orbital contusion group; ocular complications were found significantly more often in the orbital contusion group than in the orbital wall fracture group (p < 0.001). Among causes of the accident, ‘flying object’ showed the highest incidence of ocular complication at 40 of 48 eyes (85.1%). In the orbital wall fracture group, there was no significant difference in orbital fracture location, length, width or area between the ocular complication group and the non-ocular complication group.

Conclusions

Ocular complications were found significantly more often in the orbital contusion group than in the orbital wall fracture group, and ‘flying object’ showed the highest incidence of ocular complication among causes of the accident.

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Keywords: Blowout Fracture, Blunt trauma, Ocular complication

References

1. Kreidl KO, Kim DY, Mansour SE. Prevalence of significant abdominal sequelae in blunt orbital trauma. Am J Emerg Med. 2003; 21:525–8.

2. He D, Blomquist PH, Ellis E 3rd. Association between ocular abdominal and internal orbital fractures. J Oral Maxillofac Surg. 2007; 65:713–20.

3. Lee TS, Kellman R, Darling A. Crumple zone effect of nasal cavity and paranasal sinuses on posterior cranial fossa. Laryngoscope. 2014; 124:2241–6.

4. Mellema PA, Dewan MA, Lee MS, et al. Incidence of ocular injury in visually asymptomatic orbital fractures. Ophthal Plast Reconstr Surg. 2009; 25:306–8.

5. Cook T. Ocular and periocular injuries from orbital fractures. J Am Coll Surg. 2002; 195:831–4.

6. Shin JW, Lim JS, Yoo G, Byeon JH. An analysis of pure blowout fractures and associated ocular symptoms. J Craniofac Surg. 2013; 24:703–7.

7. Lee JS, Lee H, Shin H, et al. Significant intraocular sequelae in abdominalal blunt trauma and their association with blowout fracture. J Korean Ophthalmol Soc. 2012; 53:613–7.

8. Waterhouse N, Lyne J, Urdang M, Garey L. An investigation into the mechanism of orbital blowout fractures. Br J Plast Surg. 1999; 52:607–12.

9. Nagasao T, Miyamoto J, Jiang H, et al. Interaction of hydraulic and buckling mechanisms in blowout fractures. Ann Plast Surg. 2010; 64:471–6.

10. Rhee JS, Kilde J, Yoganadan N, Pintar F. Orbital blowout fractures: experimental evidence for the pure hydraulic theory. Arch Facial Plast Surg. 2002; 4:98–101.

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Figure 1.

The measurement of variables of orbital wall fracture. (A-C) Location and anterior to posterior length of orbital wall fracture. For example, Distance A to B: (The number of computed tomography [CT] cross section between A and B) × (CT slice thickness [2 mm or 3 mm]). (A) Both lacrimal crests (red arrows). (B) Starting point of orbital wall fracture (red arrow). (C) End point of orbital wall fracture (red arrow). (D, E) Longest length of orbital wall fracture. (D) Length of medial orbital wall fracture on coronal section. (E) Length of inferior orbital wall fracture on coronal section. (F-I) Orbital wall fracture areas. To calculate the area of the orbital wall fracture, we measured lengths of the orbital wall fracture in all CT section, and then multiplied it by CT slice thickness (2 mm or 3 mm). The sum of these values is orbital fracture area. For example; 4.04 × 3 + 12.49 × 3 + 6.61 × 3 + 7.68 × 3 = Orbital fracture area.

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Table 1.

Comparison of base line characteristics of patients between ocular complication group and no ocular complication group

Baseline characteristics	Total	Complications^*	No complication^†	p-value
Number of eye	169	102	67
Sex (male/female)	140/29	83/19	57/10
Laterality (OD/OS)	75/94	41/61	34/33
Age (years)	36.1 ± 17.8	35.7 ± 17.0	36.5 ± 19.1	0.770^‡
Height (cm)	168.0 ± 9.6	169.3 ± 9.5	166.3 ± 9.7	0.160^‡
Weight (kg)	67.12 ± 12.8	67.1 ± 11.1	67.0 ± 14.8	0.963^‡

Values are presented as mean ± SD unless otherwise indicated.

^* One or more ocular complications group

^† No ocular complications group

^‡ Based on student t-test.

Table 2.

Comparing frequency of ocular complication between orbital contusion group and orbital wall fracture group

Ocular complication	Orbital contusion^* (n = 102)	Orbital wall fracture^† (n = 67)	p-value^§
Commotio retinae	40 (40.4)	19 (28.4)	0.112
Traumatic iritis	47 (46.1)	13 (19.4)	<0.001
Hyphema	20 (19.6)	2 (2.9)	0.002
Angle recession	5 (4.9)	2 (2.9)	0.541
Retinal hemorrhage	5 (4.9)	2 (2.9)	0.541
Cyclodialysis	4 (3.9)	0 (0)	0.101
Traumatic cataract	3 (2.9)	0 (0)	0.157
Vitreous hemorrhage	1 (0.9)	0 (0)	0.416
Lens dislocation	0 (0)	0 (0)	Not comparable
Retinal detachment	0 (0)	0 (0)	Not comparable
Eyeball rupture	0 (0)	0 (0)	Not comparable
The number of complicated eyes	^‡75 (73.5)	27 (40.2)

Values are presented as n (%) unless otherwise indicated.

^* Blunt ocular trauma without orbital wall fracture

^† Blunt ocular trauma with orbital wall fracture

^‡ Eyes which have one or more ocular complication

^§ Based on Pearson's chi-square test.

Table 3.

Variables of orbital wall fracture

Variables of orbital wall fracture	Complications group^*	No complication^†	p-value^#
Number	26	40
AP length from lacrimal crest to starting point of fracture (mm)^‡	11.3 ± 3.7	11.4 ± 2.5	0.949
AP length (mm)^†	21.8 ± 5.6	20.6 ± 5.6	0.381
Longest length in coronal plane CT (mm)^§	17.5 ± 4.1	17.1 ± 4.3	0.649
Fracture area (mm²)^Π	323.6 ± 155.1	287.6 ± 133.1	0.335

Values are presented as number or mean ± SD.

AP = anteroposterior; CT = computed tomography.

^* One or more ocular complications group

^† No ocular complication group

^‡ Measured by counting the number of CT cross sections between two points

^§ Measured by PACS program (Maroview 5.4, Infinitt, Seoul, Korea)

^Π Measured by multiplying fracture length by cross section thickness and integrating all of values

^＃ Based on student t-test.

Table 4.

Comparing cause of accident between ocular complications group and no ocular complication group

Cause of accident	Complications group^*	No complication^†	Total
Flying object	40 (85.1)	7 (14.9)	47
Falling down	22 (45.8)	26 (54.2)	48
Assault	34 (54.8)	28 (45.2)	62
Traffic accident	6 (50)	6 (50)	12
Total	102 (60.3)	67 (39.7)	169

Values are presented as number of eye (%) unless otherwise indicated.

^* One or more ocular complications group

^† No ocular complications group.

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