Gun-related orbital fractures with concurrent ocular injury result in severe vision loss
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Orbital fractures from firearms are more likely to cause severe vision loss in the presence of concurrent intraocular injuries, according to a presentation at the virtual American Academy of Ophthalmology annual meeting.
“Many of our patients that have had firearm injuries end up surviving to discharge, that doesn’t mean that they are surviving without significant morbidity attached to their injuries,” Garrett Alexander, MD, said.
Garrett and co-authors conducted a retrospective chart review of 4 years of ocular injury caused by gunshot or pellet gun at an urban level I trauma center. The study included 59 eyes of 45 patients.
The most common injury was orbital fracture, followed by open globe injuries.
Among patients with an orbital fracture, 25% had resultant visual acuity less than 20/200, and visual acuity was better than 20/200 in 72%. In 3% visual acuity was not assessed. Among open globe-injured patients, 90% had visual acuity less than 20/200, and 10% had visual acuity better than 20/200.
All six eyes with both an open globe injury and orbital fracture had visual acuity less than 20/200. Every patient with visual acuity less than 20/200 from an orbital fracture but no open globe injury had a concurrent intraocular injury.
“An isolated orbital fracture should not affect our acuity too much, unless the force from the trauma results in an intraocular injury as well,” Garrett said.
Injuries involving the eye due to firearm or pellet gun injuries are “unfortunately common and affect an overwhelmingly young population,” Garrett said.
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Garrett, A et al. Ophthalmic injuries associated with firearm trauma in an urban county hospital. Presented at: American Academy of Ophthalmology annual meeting; Nov. 13-15, 2020 (virtual meeting).
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