Rossin et al reported findings associated with substantial ocular injury in a patient with an orbital fracture. This can identify a patient who needs an urgent ophthalmologic exam. The authors are from the Massachusetts Eye and Ear and California Pacific Medical Center in San Francisco.

Patient: age >= 15 years with orbital fracture (a patient < 15 years old should have a full ophthalmologic exam regardless of findings)


Substantial ocular injury: any injury requiring urgent care or close follow-up


Exam items:

(1) blunt trauma with foreign object (odds ratio 19.4)

(2) inability to count fingers at 1-2 feet (odds ratio 10.1)

(3) roof fracture (odds ratio 9.1)

(4) diplopia on primary gaze (double vision when looking straight ahead; odds ratio 6.7)

(5) subconjunctival hemorrhage or chemosis (odds ratio 4.2)


score =

= SUM(number of items present)



minimum score: 0

maximum score: 5

A score >=1 is an indication for urgent ophthalmologic exam.

A score = 0 indicates the need for an ophthalmologic exam within 1 week.



The negative predictive value was 96.8%. The positive predictive value was 32%.

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