Evidence-Informed Triage for Ophthalmology Consultation in Orbital Fracture Patients at Risk for Open Globe Injury
Abstract
Orbital fractures are common in facial trauma, yet only a subset of patients sustain vision-threatening ocular injuries such as open globe injury (OGI) requiring emergent ophthalmic intervention. Prior national electronic health record analysis demonstrates measurable but non-universal co-occurrence between orbital fracture and OGI, supporting development of risk-based rather than reflexive consultation strategies. We performed a targeted synthesis of peer-reviewed ophthalmology, emergency medicine, trauma surgery, and radiology literature to identify reproducible clinical and imaging predictors of severe ocular injury in orbital fracture patients and to translate convergent findings into a practical, risk-stratified consultation framework. Across heterogeneous retrospective cohorts, decreased visual acuity and pupillary abnormalities demonstrate the strongest and most consistent associations with severe ocular injury, with reported odds ratios up to approximately 14-45 for poor vision and relative afferent pupillary defect. Additional high-risk features identified in validated bedside tools include inability to count fingers (OR ~10), foreign-object mechanism (OR ~19), orbital roof fracture (OR ~9), conjunctival hemorrhage or chemosis, and primary-gaze diplopia within multivariable screening models. Published triage protocols, including STOP, HOPE, and other orbital fracture screening criteria, demonstrate high sensitivity for detecting substantial ocular injury and support selective consultation when high-risk features are absent and examination is reliable. CT imaging may support suspicion for OGI through findings such as globe contour abnormality, intraocular air, or intraocular foreign body; however, reported sensitivity for occult rupture remains limited (~50-70%), reinforcing that clinical examination remains the primary driver of triage decisions. Literature synthesis supports a risk-stratified approach to ophthalmology consultation in orbital fracture patients, prioritizing emergent evaluation when OGI is suspected and urgent or outpatient follow-up when validated high-risk features are absent. Prospective validation and local workflow adaptation are warranted.
Start Time
15-4-2026 9:00 AM
End Time
15-4-2026 12:00 PM
Room Number
Culp Ballroom 316
Poster Number
20
Presentation Type
Poster
Presentation Subtype
Posters - Competitive
Presentation Category
Health
Student Type
Graduate and Professional Degree Students, Residents, Fellows
Faculty Mentor
Brent Aebi
Evidence-Informed Triage for Ophthalmology Consultation in Orbital Fracture Patients at Risk for Open Globe Injury
Culp Ballroom 316
Orbital fractures are common in facial trauma, yet only a subset of patients sustain vision-threatening ocular injuries such as open globe injury (OGI) requiring emergent ophthalmic intervention. Prior national electronic health record analysis demonstrates measurable but non-universal co-occurrence between orbital fracture and OGI, supporting development of risk-based rather than reflexive consultation strategies. We performed a targeted synthesis of peer-reviewed ophthalmology, emergency medicine, trauma surgery, and radiology literature to identify reproducible clinical and imaging predictors of severe ocular injury in orbital fracture patients and to translate convergent findings into a practical, risk-stratified consultation framework. Across heterogeneous retrospective cohorts, decreased visual acuity and pupillary abnormalities demonstrate the strongest and most consistent associations with severe ocular injury, with reported odds ratios up to approximately 14-45 for poor vision and relative afferent pupillary defect. Additional high-risk features identified in validated bedside tools include inability to count fingers (OR ~10), foreign-object mechanism (OR ~19), orbital roof fracture (OR ~9), conjunctival hemorrhage or chemosis, and primary-gaze diplopia within multivariable screening models. Published triage protocols, including STOP, HOPE, and other orbital fracture screening criteria, demonstrate high sensitivity for detecting substantial ocular injury and support selective consultation when high-risk features are absent and examination is reliable. CT imaging may support suspicion for OGI through findings such as globe contour abnormality, intraocular air, or intraocular foreign body; however, reported sensitivity for occult rupture remains limited (~50-70%), reinforcing that clinical examination remains the primary driver of triage decisions. Literature synthesis supports a risk-stratified approach to ophthalmology consultation in orbital fracture patients, prioritizing emergent evaluation when OGI is suspected and urgent or outpatient follow-up when validated high-risk features are absent. Prospective validation and local workflow adaptation are warranted.
