Symptom Manifestation Indicates Severity of Fracture-Derived Ocular Injury

Vignesh Subramanian ’24

Figure 1: The orbit, or eye socket, of the human eye.

Orbital fractures are breakages in one or more of the bones surrounding the eyeball (collectively known as the orbit or eye socket) that are typically caused by blunt force trauma to the face. While not common, such fractures may cause serious ocular injury, which in turn may result in blurred or double vision, prolonged ocular or facial pain, poorer visual acuity, afferent or abnormal pupillary defects or reactions, ruptured globes, or eyeball displacement. Despite such clinical manifestations being well characterized, they are not fully predictive of the severity of the causative ocular injuries, hampering the development of triage criteria for urgent ophthalmologic consultation and the diagnostic process. Researchers at Stony Brook University led by Dr. Zhong thus worked to identify factors predictive of the degree of ocular injury in patients presenting to the emergency department with blunt trauma orbital fractures. 

The researchers designed a retrospective study spanning three years examining the records of 186 adult patients who had sustained one or more orbital fractures and were treated at Stony Brook University Hospital. This study documented the causes, locations, and complications of the patients’ orbital fractures and whether each patient required emergent surgical intervention. Researchers analyzed this data using multinomial regression. Finally, the injuries studied were categorized by level of severity (“mild,” “moderate,” and “severe”) and type of injury (largely concerning whether one of the following was involved: bleeding in the eye, in a form of hyphema or hemorrhaging; cuts, tears, or swelling, in the form of a laceration or iritis; or nerve damage, in the form of neuropathy). 

The researchers found that a statistically significant association existed between “severe” ocular injury and three examination findings: poor vision, afferent pupillary defect, and abnormal pupillary reaction, the last of which is also associated with “moderate” injury. The researchers further discovered that three other symptoms — blurry vision, ocular pain, and facial pain — correlated with an increased risk of “severe” ocular injury. Taken together, these findings underscore the fact that certain manifestations may prove to be reliable early indicators of vision-threatening complications, as well as the fact that most orbital fractures are not associated with significant ocular injury (with less than a third of patients requiring urgent ophthalmologic consultation). Future studies may explore the fracture characteristics and complexity or mechanisms of injury in more depth to make examination findings far more determinative of the severity of ocular injuries. 

Works Cited:

[1] E. Zhong, et al., Orbital Fractures and Risk Factors for Ocular Injury. Journal of Clinical Ophthalmology 16, 4153-4161 (2022). doi: 10.2147/OPTH.S391175

[2] Image retrieved from:


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