Forensic and Clinical Evaluation of Orbital Morphometry, Ocular Physiological Dysfunction, and Injury Severity as Predictors of Visual Outcomes Following Orbital Fracture Reconstruction

Abstract

Background: Orbital fractures may cause persistent visual dysfunction despite successful anatomical reconstruction. Combining radiological morphometry with ocular physiological assessment and injury severity may improve prediction of postoperative visual recovery.

Objective: To evaluate orbital morphometric parameters, ocular physiological dysfunction, and injury severity as predictors of visual outcomes following orbital fracture reconstruction.

Methods: This prospective observational study included 100 adults with unilateral traumatic orbital fractures treated at Amna Inayat Medical College, Sheikhupura, Pakistan, from January 2024 to December 2025. Preoperative computed tomography was used to assess fracture defect area, orbital volume difference, herniated tissue volume, and fracture displacement. Ophthalmic evaluation included best-corrected visual acuity, pupillary responses, color vision, diplopia, intraocular pressure, and extraocular movements. Patients were followed for three months—multivariable logistic regression identified independent predictors of unfavorable visual outcome.

Results: Seventy-six patients achieved favorable visual recovery, whereas 24 had unfavorable outcomes. Poor outcomes were associated with larger fracture defects, greater orbital volume difference, increased tissue herniation, impaired preoperative visual acuity, relative afferent pupillary defect, and marked extraocular movement restriction. Independent predictors included relative afferent pupillary defect, orbital volume difference ≥15%, moderate-to-marked motility restriction, high injury severity, preoperative BCVA >0.50 logMAR, and reconstruction after 14 days. The combined model showed good discrimination and supported the complementary prognostic value of structural and functional parameters in postoperative visual assessment.

Conclusion: Integrated assessment of orbital structure, ocular physiology, and injury severity may improve prognostic stratification, surgical decision-making, patient counseling, and surveillance after orbital fracture reconstruction.