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JINJ-5662; No. of Pages 1 Injury, Int. J. Care Injured xxx (2014) xxx–xxx
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Letter to the Editor Clinical features of periorbital ecchymosis in a series of trauma patients
possibility of ocular involvement in patients with periorbital ecchymosis secondary to trauma.
We read with interest the article by Somasundaram et al. [1] describing the clinical features of periorbital ecchymosis in a series of trauma patients. In their manuscript, the authors mentioned that ‘‘no patients in our series had decreased visual acuity, which is consistent with the fact that there is no intraocular involvement in traumatic periorbital ecchymosis’’. While those findings are interesting, we would like to highlight to readers that patients manifesting with periorbital ecchymosis in the context of blunt trauma could potentially have ocular involvement, some of which could be serious or even sightthreatening. In a series of 132 patients with orbital fractures, C¸ag˘atay et al. [2] reported that all patients (100%) had periorbital oedema and ecchymosis. 17% of patients had ocular involvement, which included serious and potentially sight-threatening complications, such as hyphema, traumatic uveitis, corneal perforation and pupillary sphincter rupture. Furthermore, the authors also reported a decrease in vision in 35.6% of patients with orbital fractures and periorbital ecchymosis. In another series of 150 patients with traumatic periorbital ecchymosis associated with orbital floor fractures, Gacto and Montero de Espinosa [3] reported that 15.3% of patients sustained ocular damage, with a significant proportion having traumatic globe rupture (26.1%) and hyphema (17.4%). Jabaley et al. [4] also showed in a review of 119 cases that ocular injury accompanying orbital trauma can occur in between 11 and 29%. Of these, 8.2–10% were of a permanent nature, while 31% of ocular injuries were associated with ruptured globe. From the examples highlighted, it can be seen that ocular involvement is not uncommon among trauma patients with periorbital ecchymosis, with some injuries potentially resulting in permanent loss of vision. Therefore, while we congratulate the authors on an interesting paper, we urge clinicians to consider the
Role of funding Dr. Tan receives research support from the National Healthcare Group Clinician Scientist Career Scheme Grant CSCS/12005. Dr. Tan receives travel support from Bayer. Conflict of interest statement None declared. References [1] Somasundaram A, Laxton AW, Perrin RG. The clinical features of periorbital ecchymosis in a series of trauma patients. Injury 2014;45:203–5. ¨ , Kars¸ıdag˘ S, et al. Retro[2] C¸ag˘atay HH, Ekinci M, Pamukcu C, Oba ME, Akc¸al O spective analysis of 132 patients with orbital fracture. Ulus Travma Acil Cerrahi Derg 2013;19:449–55. [3] Gacto P, Montero de Espinosa I. Retrospective survey of 150 surgically treated orbital floor fractures in a trauma referral centre. Eur J Plast Surg 2009;32:23–8. [4] Jabaley ME, Lerman M, Sanders HJ. Ocular injuries in orbital fractures. A review of 119 cases. Plast Reconstr Surg 1975;56:410–8.
Milton C. Chew Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
a
Colin S. Tana,b,* Department of Ophthalmology, Tan Tock Seng Hospital, Singapore b Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore
*Corresponding author at: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. Tel.: +65 63577726; fax: +65 63577718 E-mail address:
[email protected] (C.S. Tan).
http://dx.doi.org/10.1016/j.injury.2014.02.032 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Chew MC, Tan CS. Clinical features of periorbital ecchymosis in a series of trauma patients. Injury (2014), http://dx.doi.org/10.1016/j.injury.2014.02.032
