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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 58  |  Issue : 2  |  Page : 78-80

Clinical pattern of orbital trauma at a tertiary care center


Department of Orbit and Oculoplasty, Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai, Tamil Nadu, India

Date of Submission28-Jun-2019
Date of Acceptance03-Apr-2020
Date of Web Publication17-Jun-2020

Correspondence Address:
Dr. Geetha Periasamy
Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Egmore, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_58_19

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  Abstract 


Context: Orbital trauma occurs in a variety of settings, with road traffic accidents (RTAs) being the most common. Injuries vary in severity and have the potential for visual impairment and disfigurement. Aims: The aim of the study is to evaluate the clinical pattern of orbital injuries and its effect on visual acuity (VA). Settings and Design: This is a descriptive, cross-sectional study. Subjects and Methods: This is a descriptive, cross-sectional study of thirty patients who had attended Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai, with a history of orbital trauma. Patients were examined and information was gathered. The data were then computerized, and statistical analysis was done using SPSS. Statistical Analysis Used: SPSS software was used for statistical analysis. Results: RTA was the leading cause of orbital trauma (50%), with a female-to-male ratio of 7:23, left eye was the most commonly injured eye (57%), and the age group affected was from 21 to 40 years (60%). The most common fracture was involving the floor (47%), with direct force constituting 54% as the cause of trauma. VA remained 6/6 for a majority of cases (58%) and grossly reduced to perception of light in 6.67% of cases. The most commonly presented clinical feature was periorbital edema with ecchymosis (43%) followed by ocular movement restriction (40%). Out of the thirty cases, surgical intervention was done for 63% and medical management for 37%. Conclusion:The study concluded that each mode of injury of the orbit leads to varying clinical presentation with varying frequency of involvement of VA. Therefore, early recognition of trauma and timely intervention can result in better visual outcomes.

Keywords: Orbital fractures, orbital trauma, road traffic accidents


How to cite this article:
Periasamy G, Prakash M, Vijayakumar H, Sekar P. Clinical pattern of orbital trauma at a tertiary care center. TNOA J Ophthalmic Sci Res 2020;58:78-80

How to cite this URL:
Periasamy G, Prakash M, Vijayakumar H, Sekar P. Clinical pattern of orbital trauma at a tertiary care center. TNOA J Ophthalmic Sci Res [serial online] 2020 [cited 2020 Dec 4];58:78-80. Available from: https://www.tnoajosr.com/text.asp?2020/58/2/78/286940




  Introduction Top


The orbit is vulnerable to trauma for numerous reasons. A major incident like road traffic accident (RTA) requires urgent attention to stabilize the general condition, whereas orbit injuries are evaluated late. Therefore, precious time is lost before the treatment of the eye begins.[1] RTA-related orbital fractures are more destructive and associated with multiple orbital wall fractures. Consequently, the socioeconomic impact of orbital trauma is very high. Those affected face permanent physical disfigurement and loss of income. Hence, the aim of the study was to find the mode of ocular trauma, various clinical presentations, and their impact on visual impairment.


  Subjects and Methods Top


The descriptive study included thirty cases with a history of orbital trauma for a period of 6 months from April 2018 to September 2018, which included sixty eyes. Data regarding the case were collected on a standardized form, which included age, sex, presenting vision, duration of decreased vision, type of intervention (medical or surgical), number of follow-ups, and complications. Visual acuity (VA) was recorded by Snellen's chart. A detailed history and examination were done. Examination of the anterior segment was performed by a slit lamp, and the posterior segment was examined in the slit lamp with +90 D lens. B scan, X-ray, and computed tomography scan were done as per requirement. The datasheet also contained the type of surgical intervention and subsequent surgical intervention if needed. Patients treated medically were followed up at weekly interval for 1 month and then monthly interval for 6 months. Surgically managed patients were seen on the 1st postoperative day and then after a week. The presenting vision was categorized into poor vision (VA <6/60), moderate vision (VA ≥6/60 to ≤6/18), and good vision (VA >6/18) as shown in Graph 1. All data were analyzed using SPSS software version 19.0 (IBM SPSS Statistics 24, www.spss.co.in, India) for Windows. Statistical analysis was done, and significance of correlation for each parameter was calculated using Chi-square test and descriptive statistics. Percentages and frequencies were calculated for variables as well as clinical parameters. The mean was computed for age. [Table 1], [Table 2], [Table 3], [Table 4], [Table 5] and [Graph 1], [Graph 2] were used to present the results.
Table 1: Age distribution in the study population

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Table 2: Distribution of the injured eye

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Table 3: Distribution of various types of orbital fractures in the study population

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Table 4: Distribution of type of force involved in orbital injuries in the study population

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Table 5: Distribution of mode of injury of the orbital injuries in the study population

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  Results Top


The study included sixty eyes of thirty patients between 7 and 65 years as shown in Graph 2. The number of males was 23 and females was 7. The mean ± standard deviation of age was 22.1 ± 8.8 years, and the median age was 21 years. Distribution of age in the study population is shown in [Table 1]. Cases presented with a variety of clinical findings along with diminution of vision. We found that periorbital edema with ecchymosis was the most frequent finding (43.33%), followed by ocular movement restriction (40%). In our study, as shown in [Table 2] we had one patient with both eyes affected (3.33%), and the remaining with either of one eye affected (96.67%). Around 10% of the patients had only perception of light on their first presentation as shown in [Table 5]. We found RTA as the most common mode of injury in 15 patients (50%) followed by assault in 6 patients (20%). The most common vehicle associated with RTA was two-wheeler in 13 patients (86.67%), and as shown in [Table 4] the most common force responsible for injury was direct force in 16 patients (53.33%) as shown in [Table 3]. The commonly endured fracture in orbital trauma was floor of orbit in 14 patients (46.67%) followed by roof, medial wall, and lateral wall, with four patients each (13.33%). Orbital wall fractures were radiographically associated with maxillary sinus fracture in 12 patients (57.14%). Out of the 30 cases, 19 cases had to undergo surgical interventions such as canalicular repair with stent for lower lid tear involving the canaliculus, zygomatic elevation for zygomatic fracture, open reduction with internal fixation for Le-forte fracture, orbital floor fracture repair with inferior rectus entrapment release and use of auricular cartilage for closure of trapdoor fracture, and scleral buckling for retinal detachment. Majority of the cases (36.7%) were medically managed. The medical management included topical antibiotics, steroids, cycloplegics, and anti-inflammatory agents. Systemic medications included oral steroids, analgesics, and antibiotics (ciprofloxacin/injection cefotaxime).


  Discussion Top


The eye is protected from direct injury by lids, eyelashes, and the projecting margins of the orbit. Nevertheless, it can be injured in a variety of ways: by chemicals, heat, radiation, and mechanical trauma. Orbital trauma and the resultant loss of vision lead to psychological, economical, and professional crippling of the patient. The WHO Programme for the Prevention of Blindness suggests that annually 55 million eye injuries restrict activities more than one day, 750,000 cases require hospitalization, approximately 1.6 million go blind from injuries, 2.3 million end in bilateral low vision, and 19 million have unilateral blindness. Thomas and Alareein 2013[2] concluded that RTAs cause a greater proportion of orbital fractures in Sharjah, which is similar to our study. A retrospective study by Rhim et al.[3] also associated RTAs as the leading cause of orbital fractures. Another study in 2015[4] showed that, in orbital fractures other than pure blowout fractures, the frequency of decreased VA was higher than that of pure blowout fractures, whereas in our study, VA was good to moderate in most of the cases who had sustained orbital fractures. A 5-year retrospective analysis by Eiseman et al.[5] showed that ocular motility restriction and anterior segment abnormalities are commonly associated with orbital fractures, which is similar to our study, in which ecchymosis is the frequent finding (43.33%) followed by ocular movement restriction (40%). A retrospective review of orbital fractures by Anand and Sealey[6] demonstrated that interpersonal violence was the leading cause of orbital fractures, whereas in our study, assault was the second leading cause of orbital trauma. Katiyar et al.[7] in a pediatric population concluded that a majority of RTAs were related to two–wheelers, which is again analogous to our study. Ravindran et al.[8] in 2014 established that the most common nature of injury in RTA was a direct force, which is equivalent to our study where direct force was responsible for the orbital trauma in 53.33% of cases. Chiang et al. in 2016[9] when reviewing the location of isolated orbital fractures found that about 70.0% were floor fractures, which is comparable to our study where floor fracture constituted about 46.67%. Whereas a study in 2014 by Totir et al.[10] suggested that the most frequent fracture involved in their study was zygoma (23.6%) followed by orbital floor. Timashpolsky et al.,[11] in their study in 2016, encountered subconjunctival hemorrhage and ecchymosis as the most common presenting symptoms of facial trauma, whereas in our study of orbital trauma, periorbital edema with ecchymosis (43.33%) was the major symptom.


  Conclusion Top


The study concluded that RTAs were the most common mode of injury of orbit. The clinical presentations were varying, with majority of them having good-to-moderate vision. Medical interventions were needed predominantly, with a few warranting surgical intervention. It is the need of the hour to take precautionary measures while traveling and at workplace, such as wearing helmets and protective goggles, to prevent trauma and other morbidities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Roshmi G, Santhosh G. Orbital trauma. In: Chaudhuri Z, Vanathi M, editors. Postgraduate Ophthalmology. 1st ed. New Delhi: Jaypee Brothers Medical Publishers; 2012.  Back to cited text no. 1
    
2.
Thomas S, Alaree A. A study on causes and pattern of orbital fractures in Sharjah UAE in 2013. Int J Oral Maxillofac Surg 2013;42:1235.  Back to cited text no. 2
    
3.
Rhim CH, Scholz T, Salibian A, Evans GR. Orbital floor fractures: A retrospective review of 45 cases at a tertiary health care center. Craniomaxillofac Trauma Reconstr 2010;3:41-7.  Back to cited text no. 3
    
4.
Kim YS, Kim JH, Hwang K. The frequency of decreased visual acuity in orbital fractures. J Craniofac Surg 2015;26:1581-3.  Back to cited text no. 4
    
5.
Eiseman H, Rauser M, Terrill S, Choi E. Review of ocular findings in patients with orbital wall fractures: A 5-year retrospective analysis. Investigative Ophthalmology & Visual Science 2014;55:2784.  Back to cited text no. 5
    
6.
Anand L, Sealey C. Orbital fractures treated in Auckland from 2010-2015: Review of patient outcomes. N Z Med J 2017;130:21-6.  Back to cited text no. 6
    
7.
Katiyar V, Bangwal S, Gupta S, Singh V, Mugdha K, Kishore P. Ocular trauma in Indian pediatric population. J Clin Ophthalmol Res 2016;4:19-23.  Back to cited text no. 7
  [Full text]  
8.
Ravindran R, Sabharwal S, Prabhakar S. A prospective study on the incidence and pattern of orbital fractures and ocular complications in two wheeler drivers following road traffic accidents in South India. Investigative Ophthalmology & Visual Science 2014;55:5490.  Back to cited text no. 8
    
9.
Chiang E, Saadat LV, Spitz JA, Bryar PJ, Chambers CB. Etiology of orbital fractures at a level I trauma center in a large metropolitan city. Taiwan J Ophthalmol 2016;6:26-31.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Totir M, Ciuluvica R, Dinu I, Careba I, Gradinaru S. Biomaterials for orbital fractures repair. J Med Life 2014;7:62-4.  Back to cited text no. 10
    
11.
Timashpolsky A, Dagum AB, Sayeed SM, Romeiser JL, Rosenfeld EA, Conkling N. A prospective analysis of physical examination findings in the diagnosis of facial fractures: Determining predictive value. Plast Surg (Oakv) 2016;24:73-9.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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