Significance of subconjunctival hemorrhage in predicting ocular pathology for patients with orbital fracture

Subconjunctival hemorrhage (SCH) is a common presentation in patients with orbital trauma and often warrants investigation of underlying ocular pathology. Our study aims to assess the significance of SCH severity, graded in a spatial 0–360° manner, as a predictor for ocular pathology in patients with orbital fracture. Retrospective chart review. Patients with fractured orbits (n = 265) presenting to a level 1 trauma centre between August 2015 and January 2018. Key elements of ophthalmic assessment, including visual acuity, SCH (0–360°), anterior- and posterior-segment examination, Hertel exophthalmometry, and ocular pathology, were recorded. Simple logistic regression assessed for association between SCH severity and ocular pathology. Odds ratios (ORs) were calculated with 95% CI. Among the 265 fractured orbits, 158 (59.6%) presented with no SCH, and 107 (40.4%) had some degree of SCH. Ocular pathology was noted in 24 fractured orbits (9%). Most common pathologies included entrapment (22.2%), hyphema (16.7%), traumatic optic neuropathy (8.3%), and commotio retinae (8.3%). Simple logistic regression revealed a higher incidence of ocular pathology with increasing severity of SCH from 0–360° (OR = 1.004; 95% CI 1.001–1.007; p = 0.0085). In addition, χ2 analysis demonstrated a higher proportion of ocular pathology in 181–270° (25.0%; p = 0.0466) and 271–360° SCH subgroups (26.3%; p = 0.0031) compared with the 0° SCH subgroup (6.3%). Our findings suggest that there is some correlation between the extent of SCH and ocular pathology. However, patient care and investigations should continue to be directed by a full clinical assessment of patients with orbital trauma. Il n'est pas rare qu'une hémorragie sous-conjonctivale (HSC) apparaisse au décours d'un traumatisme orbitaire, ce qui motive souvent la recherche de lésions oculaires sous-jacentes. Notre étude visait à évaluer l'importance de la gravité de l'HSC – mesurée en fonction d'un cercle de 0 à 360° – à titre de facteur prédictif de lésions oculaires chez des patients qui ont subi une fracture orbitaire. Étude rétrospective de dossiers médicaux. Patients qui ont subi une fracture orbitaire (n = 265) et qui se sont présentés à un centre de traumatologie de niveau 1 entre août 2015 et janvier 2018. Ont été notés les éléments clés de l’évaluation ophtalmologique, soit l'acuité visuelle, l'HSC (0–360°), les résultats de l'examen des segments antérieur et postérieur, les mesures obtenues à l'exophtalmomètre de Her