Clinical Correlations of Extraocular Motility Limitation Pattern in Orbital Fracture Cases: A Retrospective Cohort Study in a Level 1 Trauma Centre
Authors: Fares Alsaleh, Emmanuel I. Nassrallah, Judy Gaffar, Matthew Kondoff, Georges Nassrallah, Micheal Ross, Jean Deschenes.
Author Disclosure Block: F. Alsaleh: None. E.I. Nassrallah: None. J. Gaffar: None. M. Kondoff: None. G. Nassrallah: None. M. Ross: None. J. Deschenes: None.
Ocular pathology following orbital trauma can vary vastly in type of pathology
and urgency. Extra-ocular motility (EOM) limitations are frequently present in
cases of orbital trauma. Limitations of the EOM of an eye can be symmetrical or
asymmetrical. The aim of this study was to identify if there was any
association between increased ocular pathology following orbital trauma in
cases that had symmetrical or asymmetrical limitation of extraocular movements.
Study Design: This is a retrospective cohort study of patients with orbital fractures and with or without EOM limitations.
Methods: Patients from a level 1 trauma center with orbital fractures for which ophthalmology was consulted were included in the study. Patient data was taken from their respective charts. Patient ocular pathology and EOM limitations at initial visit were recorded and odds ratios were calculated with 95% confidence intervals.
Results: 240 orbits with wall fractures, their extra-ocular movements and subsequent ocular pathology were identified. In cases with symmetrical and asymmetrical extra-ocular movement limitations, 5 (2.1%) and 9 (4%) cases, respectively, had significant ocular pathology. Cases with no extra-ocular limitation had 10 (4.2%) cases with ocular pathology. We conducted a Pearson chi-square test, that showed a significant relationship between EOM limitation and increased ocular pathology following orbital trauma (p=0.000081). Cases with asymmetrical EOM limitation were 5.22 (CI 95% 13.9-1.9) times more likely to develop ocular pathology than cases with no limitation of EOMs, while cases with symmetrical EOM limitation were 7.9 (CI 95% 27.2-2.3) times more likely. Cases with symmetrical EOM limitations were 1.6 (CI 95% 6.2-0.4) times more likely to develop ocular pathology than cases with asymmetrical EOM limitation. Ocular pathology in asymmetrical EOM limitation was mainly muscle entrapment, however in symmetrical limitation the pathology varied including orbital compartment syndrome, hyphema, traumatic uveitis and cataract, and lens dislocation. If muscle entrapment is excluded from the analyses, cases with symmetrical EOM limitation are 8 (CI 95% 47.7-1.3) times more likely to develop intra-ocular pathology than cases with asymmetrical limitation of EOMs.
Conclusions: Ocular pathology is frequently found following cases of orbital trauma. EOM limitations are a strong indicator for clinicians to anticipate ocular pathology. Intra-ocular injury may be more likely in cases of symmetrical EOM limitation, due to possible higher impact trauma to the eye. Future prospective