Blunt facial trauma as a predictor of ocular injury in polytrauma patients: a cross-sectional study
Medical hypothesis, discovery & innovation in optometry,
Vol. 6 No. 3 (2025),
21 November 2025
,
Page 86-91
https://doi.org/10.51329/mehdioptometry227
Abstract
Background: Ocular injury is a clinically significant complication of facial trauma, yet its burden and predictors in polytrauma remain undercharacterized. Understanding these associations is essential for optimizing early ophthalmic assessment, particularly in settings with high rates of road traffic injuries.Methods: This retrospective cross-sectional study included polytrauma patients (injury severity score [ISS] >15) admitted to a tertiary trauma center over a five-year period. Eligible patients sustained blunt injuries and underwent standardized craniofacial CT and ophthalmic assessment. Facial trauma was identified using International Classification of Diseases, Tenth Revision (ICD-10) codes and radiologic confirmation. Ocular injuries were classified according to Birmingham Eye Trauma Terminology System criteria. Data on demographics, injury mechanisms, and clinical findings were extracted for analysis.
Results: Among 7456 polytrauma patients (mean age 38.7 years), 68.2% (5085) were male and 1491 (20.0%) had blunt facial trauma. Ocular injury occurred in 20.9% (n = 312) of patients with facial trauma versus 4.2% (n = 251) without. Midface fractures were strongly associated with orbital injury, whereas mandibular fractures were associated with ocular adnexal trauma (both P < 0.001). The most frequent ocular findings were orbital fracture (n = 312/142, 45.5%), subconjunctival hemorrhage (n = 312/88, 28.2%), hyphema (n = 312/46, 14.7%), and globe rupture (n = 312/12, 3.8%). Subgroup analyses further demonstrated that road traffic accidents (RTAs) mechanism conferred more than twice the risk of ocular injury compared with other mechanisms. Multivariate logistic regression analysis identified blunt facial trauma (adjusted odds ratio [OR], 3.82; 95% confidence interval [CI], 2.91–5.02; P < 0.001), RTAs (adjusted OR, 2.14; 95% CI, 1.67–2.75; P < 0.001), male sex (adjusted OR, 1.45; 95% CI, 1.12–1.88; P = 0.005), higher ISS (adjusted OR, 1.06 per point; CI, 95%, 1.03–1.09; P < 0.001), and increasing age (adjusted OR, 1.02 per year; 95% CI, 1.00–1.04; P < 0.005) as independent predictors of ocular injury. Baseline visual impairment (VA < 20/40) was present in 38.2% of affected patients. The incidence of facial trauma showed a slight upward trend from 2021 to 2025, albeit not statistically significant (P > 0.05).
Conclusions: Ocular injury represents a substantial and clinically important component of polytrauma involving the face. Patients with blunt facial trauma, particularly those with RTAs mechanisms, are at markedly elevated risk of ocular injury. Age, sex, fracture pattern, injury mechanism, and overall trauma severity are key determinants of ocular morbidity, underscoring the need for integrated maxillofacial-ophthalmic management strategies within trauma care systems.
Keywords:
- multiple traumas
- polytrauma
- injury severity scores
- ISS score
- glasgow coma scale
- faces
- facial injury
- reduced vision
- traffic accident
- incidences
References
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21. Shukla B, Agrawal R, Shukla D, Seen S. Systematic analysis of ocular trauma by a new proposed ocular trauma classification. Indian J Ophthalmol. 2017 Aug;65(8):719-722. doi: 10.4103/ijo.IJO_241_17. PMID: 28820158; PMCID: PMC5598183.
22. Xiao JH, Zhang MN, Li SY, Jiang CH, Jiang H, Zhang Y, Qiu HY. A new classification for epidemiological study of mechanical eye injuries. Chin J Traumatol. 2014;17(1):35-7. PMID: 24506921.
23. Jain S, Margetis K, Iverson LM. Glasgow Coma Scale. 2025 Jun 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30020670.
24. Zhou HH, Liu Q, Yang RT, Li Z, Li ZB. Ocular trauma in patients with maxillofacial fractures. J Craniofac Surg. 2014 Mar;25(2):519-23. doi: 10.1097/SCS.0000000000000683. PMID: 24561369.
25. Eng JF, Younes S, Crovetti BR, Williams KJ, Haskins AD, Hernandez DJ, Yen MT, Olson KL, Allen RC, Sivam SK. Characteristics of Orbital Injuries Associated with Maxillofacial Trauma. Laryngoscope. 2023 Jul;133(7):1624-1629. doi: 10.1002/lary.30477. Epub 2022 Nov 3. PMID: 36326100.
26. Panshak TE, Akhiwu BI, Ramyil AV, Saleh N, Wade P, Ladeinde AL, Mpyet C. Ophthalmic Injuries in Patients with Maxillofacial Trauma Presenting to a Teaching Hospital in North Central Nigeria. J West Afr Coll Surg. 2022 Jul-Sep;12(3):17-23. doi: 10.4103/jwas.jwas_91_22. Epub 2022 Oct 6. PMID: 36388734; PMCID: PMC9641739.
2. Lupascu IT, Hostiuc S, Minoiu CA, Hostiuc M, Popa BV. Comparison of Traumatic Brain Injury in Adult Patients with and without Facial Fractures. Tomography. 2024 Sep 24;10(10):1534-1546. doi: 10.3390/tomography10100113. PMID: 39453030; PMCID: PMC11511231.
3. Bocchialini G, Castellani A. Facial Trauma: A Retrospective Study of 1262 Patients. Ann Maxillofac Surg. 2019 Jan-Jun;9(1):135-139. doi: 10.4103/ams.ams_51_19. PMID: 31293942; PMCID: PMC6585199.
4. Perry M, Dancey A, Mireskandari K, Oakley P, Davies S, Cameron M. Emergency care in facial trauma--a maxillofacial and ophthalmic perspective. Injury. 2005 Aug;36(8):875-96. doi: 10.1016/j.injury.2004.09.018. Epub 2005 Mar 24. PMID: 16023907.
5. Brandt MT, Haug RH. Traumatic hyphema: a comprehensive review. J Oral Maxillofac Surg. 2001 Dec;59(12):1462-70. doi: 10.1053/joms.2001.28284. PMID: 11732035.
6. Balla SC, Jha KN, Ramanujam S, Srikanth K, Rajalakshmi AR. Maxillofacial trauma and ocular injuries: reports from a prospective study from Pondicherry, India. Orbit. 2022 Aug;41(4):457-463. doi: 10.1080/01676830.2021.1939727. Epub 2021 Jul 12. PMID: 34253120.
7. Kolivand P, Saberian P, Namdar P, Karimi F, Rajaie S, Raadabadi M, Azari S. Economic Burden of Trauma-Related Injuries in Iran in 2019. Bull Emerg Trauma. 2024;12(2):67-72. doi: 10.30476/beat.2024.102266.1507. PMID: 39224469; PMCID: PMC11366267.
8. Haji Aghajani M, Haddadi M, Saadat S. Epidemiological Pattern of Injuries in Iran; a Nationwide Review of Seven Million Emergency Department Admissions. Emerg (Tehran). 2017;5(1):e10. Epub 2017 Jan 8. PMID: 28286817; PMCID: PMC5325878.
9. Jain SM, Gehlot N, Kv A, Prasad P, Mehta P, Paul TR, Dupare A, Cvns CS, Rahman S. Ophthalmic Complications in Maxillofacial Trauma: A Prospective Study. Cureus. 2022 Aug 2;14(8):e27608. doi: 10.7759/cureus.27608. PMID: 36059327; PMCID: PMC9433813.
10. Septa D, Newaskar VP, Agrawal D, Tibra S. Etiology, incidence and patterns of mid-face fractures and associated ocular injuries. J Maxillofac Oral Surg. 2014 Jun;13(2):115-9. doi: 10.1007/s12663-012-0452-9. Epub 2012 Dec 6. PMID: 24822001; PMCID: PMC4016399.
11. Mir A, Baseri MM, Farmanfarma KK. Factors affecting ocular trauma in Iran: A systematic review study. Health Sci Rep. 2024 Aug 30;7(9):e2281. doi: 10.1002/hsr2.2281. PMID: 39221056; PMCID: PMC11362837.
12. Georgouli T, Pountos I, Chang BY, Giannoudis PV. Prevalence of ocular and orbital injuries in polytrauma patients. Eur J Trauma Emerg Surg. 2011 Apr;37(2):135-40. doi: 10.1007/s00068-010-0029-6. Epub 2010 Jun 12. PMID: 26814952.
13. Guly CM, Guly HR, Bouamra O, Gray RH, Lecky FE. Ocular injuries in patients with major trauma. Emerg Med J. 2006 Dec;23(12):915-7. doi: 10.1136/emj.2006.038562. PMID: 17130597; PMCID: PMC2564251.
14. Seif M, Edalat S, Majidpour Azad Shirazi A, Alipouri S, Bayati M. Prediction of the burden of road traffic injuries in Iran by 2030: Prevalence, death, and disability-adjusted life years. Chin J Traumatol. 2024 Jul;27(4):242-248. doi: 10.1016/j.cjtee.2024.02.004. Epub 2024 Feb 24. PMID: 38503589; PMCID: PMC11357753.
15. Shahbazi F, Hashemi Nazari SS, Soori H, Khodakarim S. Socioeconomic Inequality in Mortality from Road Traffic Accident in Iran. J Res Health Sci. 2019 Jan 9;19(1):e00437. PMID: 31133631; PMCID: PMC6941628.
16. Roshanfekr P, Khodaie-Ardakani MR, Malek Afzali Ardakani H, Sajjadi H. Prevalence and Socio-Economic Determinants of Disabilities Caused by Road Traffic Accidents in Iran; A National Survey. Bull Emerg Trauma. 2019 Jan;7(1):60-66. doi: 10.29252/beat-070109. PMID: 30719468; PMCID: PMC6360010.
17. Hildebrand F, Lefering R, Andruszkow H, Zelle BA, Barkatali BM, Pape HC. Development of a scoring system based on conventional parameters to assess polytrauma patients: PolyTrauma Grading Score (PTGS). Injury. 2015 Oct;46 Suppl 4:S93-8. doi: 10.1016/S0020-1383(15)30025-5. PMID: 26542873.
18. World Health Organization (2022). ‘ICD-10 Version:2019: Superficial injury of head, Fracture of skull and facial bones, and Injury of eye and orbit’. Available at: https://icd.who.int/browse10/2019/en#S00.1 (Accessed: August 10, 2025)
19. Kuhn F, Morris R, Witherspoon CD, Mester V. The Birmingham Eye Trauma Terminology system (BETT). J Fr Ophtalmol. 2004 Feb;27(2):206-10. doi: 10.1016/s0181-5512(04)96122-0. PMID: 15029055.
20. Kuhn F, Morris R. A quarter of a century of the Birmingham Eye Trauma Terminology (BETT) system. Graefes Arch Clin Exp Ophthalmol. 2021 Oct;259(10):2867-2868. doi: 10.1007/s00417-021-05407-6. Epub 2021 Sep 6. PMID: 34487225.
21. Shukla B, Agrawal R, Shukla D, Seen S. Systematic analysis of ocular trauma by a new proposed ocular trauma classification. Indian J Ophthalmol. 2017 Aug;65(8):719-722. doi: 10.4103/ijo.IJO_241_17. PMID: 28820158; PMCID: PMC5598183.
22. Xiao JH, Zhang MN, Li SY, Jiang CH, Jiang H, Zhang Y, Qiu HY. A new classification for epidemiological study of mechanical eye injuries. Chin J Traumatol. 2014;17(1):35-7. PMID: 24506921.
23. Jain S, Margetis K, Iverson LM. Glasgow Coma Scale. 2025 Jun 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30020670.
24. Zhou HH, Liu Q, Yang RT, Li Z, Li ZB. Ocular trauma in patients with maxillofacial fractures. J Craniofac Surg. 2014 Mar;25(2):519-23. doi: 10.1097/SCS.0000000000000683. PMID: 24561369.
25. Eng JF, Younes S, Crovetti BR, Williams KJ, Haskins AD, Hernandez DJ, Yen MT, Olson KL, Allen RC, Sivam SK. Characteristics of Orbital Injuries Associated with Maxillofacial Trauma. Laryngoscope. 2023 Jul;133(7):1624-1629. doi: 10.1002/lary.30477. Epub 2022 Nov 3. PMID: 36326100.
26. Panshak TE, Akhiwu BI, Ramyil AV, Saleh N, Wade P, Ladeinde AL, Mpyet C. Ophthalmic Injuries in Patients with Maxillofacial Trauma Presenting to a Teaching Hospital in North Central Nigeria. J West Afr Coll Surg. 2022 Jul-Sep;12(3):17-23. doi: 10.4103/jwas.jwas_91_22. Epub 2022 Oct 6. PMID: 36388734; PMCID: PMC9641739.
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