Blunt facial trauma as a predictor of ocular injury in polytrauma patients: a cross-sectional study

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] >۱۵) 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-۱۰) 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 ۷۴۵۶ polytrauma patients (mean age ۳۸.۷ years), ۶۸.۲% (۵۰۸۵) were male and ۱۴۹۱ (۲۰.۰%) had blunt facial trauma. Ocular injury occurred in ۲۰.۹% (n = ۳۱۲) of patients with facial trauma versus ۴.۲% (n = ۲۵۱) without. Midface fractures were strongly associated with orbital injury, whereas mandibular fractures were associated with ocular adnexal trauma (both P < ۰.۰۰۱). The most frequent ocular findings were orbital fracture (n = ۳۱۲/۱۴۲, ۴۵.۵%), subconjunctival hemorrhage (n = ۳۱۲/۸۸, ۲۸.۲%), hyphema (n = ۳۱۲/۴۶, ۱۴.۷%), and globe rupture (n = ۳۱۲/۱۲, ۳.۸%). 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], ۳.۸۲; ۹۵% confidence interval [CI], ۲.۹۱–۵.۰۲; P < ۰.۰۰۱), RTAs (adjusted OR, ۲.۱۴; ۹۵% CI, ۱.۶۷–۲.۷۵; P < ۰.۰۰۱), male sex (adjusted OR, ۱.۴۵; ۹۵% CI, ۱.۱۲–۱.۸۸; P = ۰.۰۰۵), higher ISS (adjusted OR, ۱.۰۶ per point; CI, ۹۵%, ۱.۰۳–۱.۰۹; P < ۰.۰۰۱), and increasing age (adjusted OR, ۱.۰۲ per year; ۹۵% CI, ۱.۰۰–۱.۰۴; P < ۰.۰۰۵) as independent predictors of ocular injury. Baseline visual impairment (VA < ۲۰/۴۰) was present in ۳۸.۲% of affected patients. The incidence of facial trauma showed a slight upward trend from ۲۰۲۱ to ۲۰۲۵, albeit not statistically significant (P > ۰.۰۵). 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