Ocular Injuries in Patients with Old Blow-out Fractures Following Blunt Trauma

Purpose: To analyze the frequency, and clinical characteristics of ocular injuries in patients with prior blow-out fractures who experience new blunt trauma, and to assess whether old orbital fractures provide a protective effect against subsequent ocular trauma.

Methods: The medical records of 1,315 ocular trauma patients were reviewed. A total of 927 patients who had orbital or facial CT scans and ophthalmologist evaluations were considered. After applying exclusion criteria, 568 patients with 581 affected eyes were included in the final analysis. The patients were divided into two groups based on the presence of old blow-out fractures, identified on CT scan. The clinical characteristics and the frequency of ocular injuries were compared between the two groups. The risk of ocular injury according to the presence of old blow-out fracture ware studied using multiple logistic regression after controlling age and sex.

Results: Among the 581 eyes examined, 140 (24.1%) had old blow-out fractures. The incidence of intraocular complications was significantly higher in the no orbital fracture group (20.4%) compared to the old blow-out fracture group (2.1%) (p < 0.001). Specifically, the incidence of complications such as gross hyphema (p = 0.001), globe rupture (p = 0.006), and vitreous hemorrhage (p = 0.027) was significantly greater in the group without old blow-out fractures than in those with them. Multiple logistic regression showed that the presence of old blow-out fractures was significantly associated with reduced risk of ocular injury (p < 0.001).

Conclusions: The patients with old blow-out fractures had a lower risk of ocular injuries following subsequent blunt trauma. The findings suggest that old fractures may provide protective effect. These results may have important implications for the clinical management of patients at risk of recurrent orbital trauma.