Policy for ophthalmology consultation in patients with orbital trauma

Policy for ophthalmology consultation in patients with orbital trauma

Departments of Ophthalmology and Oral Maxillofacial Surgery

University of Kentucky

July 1, 2020

Rationale:  To provide a guideline on appropriate circumstances to consult ophthalmology in patients with orbital trauma to evaluate for concurrent ocular trauma and help guide subsequent management.

Policy

1. The ophthalmology service should be consulted on all patients with known or suspected orbital trauma, with the exception of patients that (all the following circumstances must be met):

  • Are awake, alert and able to accurately voice responses
  • Have no visual complaints when directly asked
  • Have no concerning findings on examination or imaging

Please note that the above criteria also applies to all pre-operative clearance requests. Should there be any concern for open globe, threat to globe, entrapment, or visual complaints/decreased vision the ophthalmology service should be consulted for prompt evaluation.

2. If the patient is discharged from the emergency room or hospital prior to any planned intervention, the consultation can be scheduled as an outpatient in the comprehensive ophthalmology clinic.  If intervention is required during the hospital stay or there are urgent concerns, the inpatient ophthalmology consult service can examine the patient.

3. Routine postoperative ophthalmology evaluation is unnecessary unless indicated by ophthalmology or with any concerns from either service.

4. The results of the ophthalmology consultation note should be reviewed prior to any intervention and any concerns or questions addressed.  Any urgent issues identified by either service need to be discussed verbally.

References:

Peacock ZS, Boulous T, Miller JB, et al. Orbital fractures and ocular injury: is a postoperative ophthalmology examination necessary? J Oral Maxillofac Surg 2014;72:1533-40.

Barry C, Coyle M, Idrees Z, et al. Ocular findings in patients with orbitzygomatic complex fractures: a retrospective study. J Oral Maxillofac Surg 2008;66:888-92

Jamal BT, Pfahler SM, Lane KA, et al. Ophthalmic injuries in patients with zygomaticomaxillary complex fractures requiring surgical repair. J Oral Maxillofac Surg 20009;67:986-9.

Mellema PA, Dewan MA, Lee MS, et al. Incidence of ocular injury in visually asymptomatic orbital fractures. Ophthal Plast Reconstr Surg 2009;25:306-8.

Amrith S, Saw SW, Lim TC, Lee TK. Ophthalmic involvement in cranio-facial trauma. J Craniomaxillofac Surg 2000;28:140-7.

Johnson NR, Singh NR, Otzel M, et al. Ophthalmological injuries associated with fractures of the orbitozygomaticomaxillary complex. Br J Oral Maxillofac Surg 2018.