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: Background: High-impact trauma frequently leads to injuries of the orbit, but literature
focusing on the viscerocranium rather than the neurocranium is underrepresented. Methods: Retrospective cohort study (2006–2014) at an urban level 1 trauma center assessing the frequency and
typical patterns of orbital injuries on whole-body computed tomography (WBCT) with maxillofacial
multi-slice CT (MSCT) after severe trauma. (1) Screening of consecutive WBCT cases for dedicated
maxillofacial MSCT. (2) Examination by two independent experts’ radiologists for (peri-/)orbital
injuries. (3) Case review for trauma mechanisms. Results: 1061 WBCT were included revealing 250
(23.6%) patients with orbital injuries. Less than one-quarter (23.3%) of patients showed osseous
and 9.5% showed soft tissue injuries. Combined osseous and soft tissue lesions were present in
39.2% of orbital injuries, isolated soft tissue injuries were rare. Single- or two-wall fractures of the
orbit were prevalent, and the orbital floor was affected in 67% of fractures. Dislocated extraocular
muscles (44.6%), deformation of the ocular globe (23.8%), and elongation of the optic nerve (12.9%)
were the most frequently soft tissue findings. Vascular trauma was suspected in 15.8% of patients.
Conclusions: Orbital trauma was confirmed in 23.6% of cases with suspected facial injuries after severe
trauma. Concomitant soft tissue injuries should be excluded explicitly in cases with orbital fractures
to prevent loss of vision or ocular motility.