Retrospective evaluation of ocular injuries in fractures of the zygomaticoorbital complex in a level I trauma center: is primary specialized ophthalmologic examination always necessary?

Purpose: The necessity of a specialized ophthalmological assessment following fractures of the zygomaticoorbital (ZMO) complex in an emergency setting is still debated in resource-limited health systems. The primary aim of this study was to determine the incidence and types of ocular and periocular injuries (OPIs) associated with different fracture patterns of the ZMO complex. The secondary aim was to investigate the association between patient- and trauma-specific variables with the different types of OPI and identify high-risk patients for severe OPI.

Methods: A retrospective cohort study was conducted on patients with ZMO complex fractures over a seven-year period. All patients underwent a specialized ophthalmic assessment in the ophthalmology clinic within 24 h of initial admission. Visual acuity, extraocular eye movements, and pupillary reaction were examined to determine the type of OPI that occurred. Demographic and medical history data, clinical and radiological findings and specific OPIs were recorded. Demographics, fracture patterns and ophthalmological findings were presented using descriptive statistical analysis. A multivariable analysis was performed to identify associations between predictor factors (etiology of injury, fracture pattern, pre-traumatic ophthalmological conditions, antithrombotic therapy) and OPI severity.

Results: 489 patients with a mean age of 50.88 years and a total of 540 examined eyes met the inclusion criteria. Ground-level fall was the most common etiology of injury. Periocular hematomas (28.99%), subconjunctival hemorrhage (18.65%) and periorbital swelling (15.13%) were the most common ophthalmologic findings. Eye motility disorders (p = 0.0003) and diplopia (p = 0.0019) were significantly more common in isolated orbital wall fractures than in other midface fracture patterns. Chemosis was significantly more common in fractures of the zygomaticoorbital complex (p = 0.0199), while lid tears (p = 0.0470) and open globe injuries (p = 0.0002) were more common in Le Fort fractures. Optic disc hemorrhage occurred significantly more frequently in patients under single antithrombotic therapy (p = 0.0171). Blow from blunt objects and Le Fort fractures were associated with higher rates of severe OPI, while pre-traumatic ophthalmologic conditions and antithrombotic therapy were not.

Conclusions: Within the limitations of the study, patients who experienced blows from blunt objects and those with Le Fort fractures are at a higher risk for severe OPIs. Early specialized ophthalmological consultation is recommended for patients with zygomatic fractures and orbital involvement, especially for those with visual alterations such as motility disorders and diplopia as well as those taking antithrombotic medication.