Evaluation of ocular morbidity in patients with orbital wall fractures: A prospective observational study

Abstract

Background: Orbital wall fractures are common sequelae of facial trauma and may be associated with a wide spectrum of ocular injuries ranging from minor periocular manifestations to sight-threatening complications. Early identification of ocular involvement is essential for timely management and prevention of visual morbidity. Objective: To evaluate the pattern of ocular manifestations associated with orbital wall fractures, analyse their etiological factors, and determine the distribution of fracture types. Materials and Methods: A prospective observational study was conducted on 50 patients with radiologically confirmed orbital wall fractures who presented to the Ophthalmology Outpatient and Emergency Departments of Government General Hospital, Kakinada, between May 2023 and October 2024. Detailed demographic, clinical, ophthalmological, and radiological data were collected. Patients were followed up for a minimum of one week or until resolution of clinical findings. Results: The majority of patients were males (70%), with the highest incidence observed in the 21–30-year age group (34%). Assault was the most common mechanism of injury (38%), followed by road traffic accidents (24%) and falls (20%). Most patients maintained good visual acuity, with 68% presenting with 6/6 vision. Orbital floor fractures were the most frequent fracture type (40%), followed by medial wall fractures (20%). Common ocular manifestations included subconjunctival haemorrhage (80%), periorbital oedema (42%), enophthalmos (40%), chemosis (36%), lid lacerations (30%), and traumatic mydriasis (28%). Major ocular complications were identified in 12% of patients and included Berlin’s oedema (6%), hyphema (4%), vitreous haemorrhage (2%), traumatic optic neuropathy (2%), and globe rupture (2%). Reduced visual acuity and abnormal pupillary responses were associated with clinically significant ocular injuries. Conclusion: Orbital wall fractures are frequently associated with ocular manifestations, although most are minor and self-limiting. Orbital floor fractures represent the most common fracture pattern. Patients presenting with decreased visual acuity or pupillary abnormalities are at increased risk of significant ocular injury and require urgent ophthalmologic evaluation. Early recognition of high-risk clinical features can facilitate appropriate referral and improve visual outcomes.