Background: Orbital fractures are frequently accompanied by ocular injury. Any findings that provide information for diagnosing a concurrent ocular injury should improve patient care. A greater incidence of severe ocular injury with certain fracture types was hypothesized, based on orbital wall thickness. Methods: A retrospective review of 87 consecutive patients (107 fractured orbits) was performed by the Ophthalmology Department of an urban Level 1 trauma center. Results and Conclusions: Severe injuries were associated with orbital apex fractures (p = 0.00001), with lateral wall fractures (p < 0.04), and with Le Fort Type Ill fractures (p < 0.02). Moderate injuries were associated with isolated orbital floor fractures (p < 1. 01). Apex, lateral wall, and Le Fort Type III fractures have a greater association with severe ocular injuries than other fracture types.