Ocular Pathologies After Orbital Fracture Predictable by Hemorrhage Severity

Doctor checking patient
Doctor checking patient’s eyes by using torch light.
Researchers say the severity of the damage can predict future ocular pathology.

The incidence of ocular pathology is correlated with the severity of subconjunctival hemorrhage (SCH) in patients with orbital fracture, according to research published in the Canadian Journal of Ophthalmology.

The researchers evaluated key elements of patients’ ophthalmic assessment, including visual acuity, SCH (graded spatially 0˚-360°), anterior- and posterior-segment examination, Hertel exophthalmometry, and ocular pathology. They tested the association between SCH severity and ocular pathology using a simple logistic regression.

The study included patients with orbital fracture (n=265, mean age 49.1±21.3 years, 75% men) presenting to a level 1 trauma center between August 2015 and January 2018. Of the 265 fractured orbits, some degree of SCH was present in 40.4% of patients and no SCH in 59.6% of patients. Researchers found ocular pathologies in 9% of fractured orbits. The most common pathologies were entrapment (22.2%), hyphema (16.7%), traumatic optic neuropathy (8.3%), and commotio retinae (8.3%). 

With the logistic regression, the team found a higher incidence of ocular pathology with increasing severity of SCH from 0˚ to 360° (OR 1.004; 95% CI 1.001-1.007; P =.0085). With additional analyses, they also demonstrated a higher proportion of ocular pathology in the 181˚ to 270˚ (25.0%; P =.0466) and 271˚ to 360˚ SCH subgroups (26.3%; P =.0031) compared with the 0˚ SCH subgroup (6.3%).

“To our knowledge, this study is the first to assess the significance of SCH severity in suggesting underlying ocular pathology in patients with orbital fracture,” according to the researchers. “Our findings indicate that there is some correlation between the extent of SCH and the incidence of ocular pathology; however, they are not so strong as to warrant accepting this clinical sign in directing care or investigations in the assessment and management of patients with orbital trauma.”

The researchers suggested that larger future prospective studies in orbital fracture patients, especially those with ocular pathology, are needed to validate their findings.

Limitations of the study included the retrospective, single-center design, potential inconsistency in ophthalmologists’ interpretation of the spatial degree of SCH in patients with orbital fracture, and a relatively small sample size of patients with ocular pathology. 


Dhillon J, Nassrallah G, Nithianandan H, et al. Significance of subconjunctival hemorrhage in predicting ocular pathology for patients with orbital fracture. Can J Ophthalmol. Published online March 9, 2022. doi:10.1016/j.jcjo.2022.02.003