Global epidemiology and prognostic predictors of oculofacial trauma with malignant involvement: A systematic review

Background: Oculofacial trauma is one of the leading causes of blindness, disfigurement and disability worldwide. The complexity of the issue increases significantly when malignant disease is involved in either the eye, orbit, eyelids, lacrimal system or surrounding facial anatomy. Trauma can occur in a patient with preexisting cancer, may reveal an otherwise undiagnosed malignancy, or can create the appearance of malignancy as a consequence of the findings after the trauma. On the other hand, tumor involvement can make tissue weak, inhibit wound healing, increase risk of infection and otherwise complicate the outcome of the trauma in general. Despite the frequent interaction between the two disorders, there has yet to be established a comprehensive idea on the prevalence of the association and predictors of the outcomes.Objective: This literature review attempts to consolidate current knowledge on global epidemiology, clinical characteristics, mechanisms, patterns of injury and prognostic factors of oculofacial trauma associated with malignant disease.Materials and Methods: Inclusion criteria are retrospective series, observational studies, prospective cohorts and case series, which study the cases of ocular, orbital, eyelid, lacrimal and facial trauma in patients with cancer or cases of traumatic detection of a malignancy. We seek information on patient demographics, geographic distribution, etiology, severity of the trauma, location and type of the malignancy, duration of delay until diagnosis, details of the treatment received, visual and structural outcomes, recurrence or progression of the disease, complication rate and mortality. Furthermore, prognostic factors will be investigated in four categories – those of patient, tumor, trauma and treatment.Results: There seems to be significant variation with regard to both epidemiology and outcomes within various regions and socio-economic settings. Prognostic factors of trauma cases include severity of injury, visual acuity at presentation, affected anatomical region, amount of tissue involved, presence of infection, time of presentation, and necessity for extensive surgical intervention. In case when cancer is also present, tumor type, extent, staging, laterality, age of patient, applied treatment method and whether the disease is systemic may influence survival and disease-specific outcomes. It appears that there are some interactions between various factors – especially when an injury delays diagnosis of underlying tumor or when trauma occurs in previously irradiated or otherwise altered tissues.Conclusion: Oculofacial trauma in patients with malignant disease represents an important and clinically heterogeneous intersection point between traumatology and oncology of the eye. The systematic review and meta-analysis of the evidence with regard to both epidemiology and prognosis could help physicians to diagnose occult malignancies earlier, to stratify risks of different complications and to plan further diagnosis, treatment and follow-up in a better way. Future directions should include multi-center study with standardized definitions and outcome measurements.