Evidence-Based Protocol for Ophthalmology Consult for Orbital Fractures

Abstract Background Previous retrospective studies demonstrate that urgent evaluation by an ophthalmologist for orbital fractures is not required in visually asymptomatic patients, although a consult is often seen as a necessity in many hospital institutions. To determine when an ophthalmology consult is indicated for a surgical patient, the oral and maxillofacial and ophthalmology departments at 1 institution collaborated for an evidence-based approach utilizing retrospective and prospective data. Methods The retrospective arm looked at patients from 2012-2017, who had an isolated, surgically repaired orbital fracture without pre-operative ophthalmology consultation. A prospective arm was then created from August 2019-July 2020 with a designed protocol that determined which patients required an ophthalmology consult pre-operatively. Extra-ocular movements (EOM), visual acuity, and diplopia were examined in the pre-op and postoperative setting to determine if the lack of an ophthalmology consult adversely affected patient outcome. Results Of the retrospective patients who met criteria, 82 of the 84 (98%) had a normal postoperative exam: baseline visual acuity, intact EOM, and no diplopia. The 2 of the 84 (2%) had postoperative diplopia consistent with pre-op examination. In the prospective group, 10 of 39 patients required a pre-op ophthalmology consult while 29 of 39 did not require one. A normal postoperative exam was present in 26 of the 29 patients (90%). Of those 3 remaining patients, 2 patients (7%) had postoperative diplopia consistent with preoperative while 1 patient (3%) had postoperative diplopia without pre-operative diplopia. Conclusion The authors conclude that a routine ophthalmology consult is not warranted in visually asymptomatic patients with orbital fractures requiring surgical repair.