Correlation between fracture morphology of orbital floor fractures and the incidence of retrobulbar hematoma: A retrospective radiological and clinical study

Orbital fractures are common after craniofacial trauma. A rare but severe complication is retrobulbar hematoma (RBH), potentially causing increased intraorbital pressure, optic nerve compression, and irreversible vision loss. Prompt diagnosis and emergency decompression, typically via lateral canthotomy, are critical. Despite its low incidence, the relationship between fracture morphology and RBH remains insufficiently understood. This study investigates the association between orbital floor fracture characteristics and RBH occurrence. In this retrospective single-center study, we analyzed all patients who presented to our department between 2015 and 2025 with CT-confirmed RBH and elevated intraocular pressure (IOP) following orbital trauma. CT-based fracture morphology was assessed and classified by size, fragmentation, and wall involvement. Findings were correlated with clinical parameters, including IOP, initial and postoperative visual acuity, and the need for surgical intervention. Statistical analyses evaluated associations between fracture features and clinical severity. We analyzed 27 patients with RBH following orbital trauma, mainly involving the orbital floor, typically caused by falls or assault. Ipsilateral visual acuity was initially reduced (0.15 (0.00-0.80)), improving after decompression; IOP also decreased significantly. Functional outcomes were associated with fracture pattern and, to a lesser extent, anticoagulation. Several Association of the Study of Internal Fixation (AO) fracture types correlated with clinical outcomes. Receiver operating characteristic analysis showed that orbital floor displacement predicted preoperative visual acuity (AUC = 0.75, cut-off 4.7 mm), while medial wall displacement poorly predicted IOP or vision initially. Postoperatively, medial wall displacement showed excellent discrimination for IOP normalization (AUC = 0.944); however, neither wall predicted visual outcome reliably. The extent and displacement of orbital fractures, along with intraocular pressure, strongly correlated with functional outcomes. Our findings highlight the prognostic value of CT-based fracture assessment in addition to urgent clinical evaluation and suggest that trauma mechanism and patient profile further influence risk and recovery.