Ocular or orbital trauma associated with increased risk of mortality in victims of intimate partner violence

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A new study reported that ophthalmologists are in a prime position to identify women who have been victims of intimate partner violence (IPV), according to the study authors who found that ocular or orbital trauma is a significant risk factor for mortality.¹ The study was led by first author Linus Amarikwa, MD, who is from the Department of Ophthalmology, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha.

IPV, defined as physical violence, sexual violence, stalking or psychological aggression that is committed by a current or former spouse or dating partners.^2. The consequences of IPV may include facial trauma, post-traumatic stress disorder, mood disorders, maladaptive behaviors, sexually transmitted infections, concern for safety, and missing work or school. In more severe cases, IPV may result in severe injury, lifelong disability, or death. IPV is one of the leading causes of homicide in the US, and is implicated in 55% of female homicides.³ Adult females of child-bearing age is the group that is most at risk of IPV-related mortality.⁴

Ocular trauma among women who have experienced IPV has been investigated previously.^5-7 Although ocular injuries are not as common as orbital traumas in this patient population, ocular injuries tend to be more severe. IPV is also often missed when these patients present, Amarikwa and colleagues said.

A previous study found that 80% of IPV-related ocular injuries resulted in enucleation.⁶

“Orbital trauma is relatively common in patients with a history of IPV and IPV has been found to be the third most common cause of orbital traumas.⁹ The most common types of fractures include zygomaticomaxillary complex fractures, orbital floor, and medial wall fractures.⁹ Notably, patients with IPV-related orbital trauma often present with fractures in multiple stages of healing from prior episodes.¹⁰ The leading causes of IPV-related orbital fractures include blunt trauma due to fists or other readily available household objects, and being slammed against a hard surface like a wall.¹¹ Given the severe nature of these injuries and the potential consequences, it is alarming that documentation of patient safety and referral to ancillary services is not frequently performed,⁹” the investigators stated.

Investigation of IPV

The authors conducted a retrospective study with the goal of characterizing the risk factors for mortality and the rates of mortality in women with a history of ocular or orbital trauma and IPV. Women who ranged in age from 18 to 55 years who had a variable history of IPV and orbital trauma were identified in the TriNetX Network from years 2005 to 2024. The patients were grouped based on the presence of IPV and orbital trauma and the rates of mortality, hospitalization, and emergency department visits following trauma and then analyzed.

The main outcomes were the hazard ratio (HR) for mortality and the rate of 5-year mortality.

Amarikwa and colleagues reported, “After matching and assessing the patients for the presence of ocular or orbital trauma, 2,812 patients were included in the following two groups: the IPV-related ocular or orbital trauma and IPV with no ocular or orbital trauma groups. The analysis found that a history of ocular or orbital trauma increased the risk of mortality in patients with a history of IPV (HR = 1.7, 95% confidence interval: 1.3-2.4, P < 0.001).

The authors concluded, “A history of ocular or orbital trauma is a significant risk factor for mortality among female patients with a history of IPV. High risk patients should be identified at the time of presentation and protective measures initiated.”

The advised that better practices be developed for treating patients with IPV and orbital trauma, and improved assessment of IPV outcomes is needed with a particular focus on stronger follow-up and inclusion of mortality as an outcome.

References

1. Amarikwa L, Renner LM, Homer N, et al. Ocular and orbital trauma correlated with an increased risk of mortality in female patients with a history of intimate partner violence. Am J Ophthalmol. 2025; published online Sept. 11; https://doi.org/10.1016/j.ajo.2025.09.013Get rights and content

2. Breiding M, Basile KC, Smith SG, et al. Intimate partner violence surveillance: Uniform definitions and recommended data elements.2015; version 2.0

3. Petrosky E. Racial and ethnic differences in homicides of adult women and the role of intimate partner violence—United States, 2003–2014. MMWR. 2017;66.

4. Taylor-Butts A. Section 1: Overview of family violence. Family violence in Canada: A statistical profile. 2013; 2015.

5. Wu V, Huff H, Bhandari M. Pattern of physical injury associated with intimate partner violence in women presenting to the emergency department: a systematic review and meta-analysis. Trauma Violence Abuse. 2010;11:71-82.

6. Alfaro Quezada J, Mustafa Z, Zhang X, et al. A nationwide study of intimate partner violence. Am Surg. 2020;86:1230-1237.

7. Beck SR, Freitag SK, Singer N. Ocular injuries in battered women. Ophthalmology. 1996;103:148-151

8. Cohen AR, Clark TJE, Renner LM, et al. Intimate partner violence as a mechanism of traumatic ocular injury in women. Can J Ophthalmol.2019;54:355-358.

9. Hicks PM, Murtaugh MA, DeAngelis MM. The possible impact of increased physical intimate partner violence during the COVID-19 pandemic on ocular health. SAGE Open Med. 2021; 9,20503121211035263

10. Clark TJ, Renner, LM, Sobel RK, et al. Intimate partner violence: an underappreciated etiology of orbital floor fractures. Ophthalmic Plast Reconstr Surg.2014;30:508-511.

11. Saenz NM, Tallman SD. Fracture variation in survivable versus fatal blunt force trauma associated with intimate partner violence. Forensic Sci Int. 2024;357, 112000.

12. Sheridan DJ, Nash KR. Acute injury patterns of intimate partner violence victims.Trauma Violence Abuse. 2007;8:281-289.