Forensic, Anatomical, and Physiological Predictors of Visual Outcomes Following Surgical Management of Orbital Trauma. A Clinical Study

Abstract

Background: Orbital trauma can produce persistent visual impairment through bony disruption, optic nerve injury, soft-tissue entrapment, and ocular physiological dysfunction. Identifying early predictors of visual recovery may improve surgical planning and medico-legal assessment.

Objective: To determine forensic, anatomical, and physiological predictors of visual outcome following surgical management of orbital trauma.

Methods: This prospective observational study included 80 patients treated at Amna Inayat Medical College, Sheikhupura, Pakistan, from April 2024 to April 2025. Mechanism and severity of injury, computed tomography findings, best-corrected visual acuity, pupillary responses, color vision, intraocular pressure, ocular motility, and diplopia were recorded. Visual outcome was assessed three months after surgery. Multivariable logistic regression identified independent predictors of unfavorable recovery.

Results: Favorable visual outcome was achieved in 54 patients (67.5%), while 26 (32.5%) had unfavorable recovery. Severe injury, associated facial fractures, multiple-wall fractures, globe displacement, orbital volume alteration, optic canal involvement, retrobulbar hematoma, impaired color vision, marked ocular motility restriction, and persistent diplopia were significantly associated with poorer outcomes. Relative afferent pupillary defect was the strongest independent predictor of unfavorable recovery (adjusted OR 7.21), followed by optic canal involvement (adjusted OR 5.63), preoperative visual acuity worse than 0.70 logMAR (adjusted OR 4.48), severe injury, and surgery performed more than 14 days after trauma.

Conclusion: Visual prognosis after orbital trauma depends on injury severity, orbital anatomy, and ocular physiological function. Early recognition of optic nerve dysfunction and posterior orbital involvement may support timely surgery, prognostic counseling, and forensic documentation.