Ophthalmic Injuries Associated with Facial Trauma

Purpose Severe ophthalmic injuries determining loss of visual function, in particular those associated with maxillofacial fractures, are rare. The aim of the study is to present our experience in patients with severe ophthalmic injuries associated with facial fractures. Material and Methods Between 2001 and 2009, 1779 patients were admitted for facial fractures in our Division. Only patients with preoperative CT scans and a partial or total loss of vision at first rapid ophthalmological assessment were included in the study Data collected included age, gender, mechanism of injury, location of facial fractures, type of ocular injuries, treatment and days of hospitalization Results Forty patients (2,2%), 32 men and 8 women, (mean age 42 years), presented a severe reduction of vision or blindness because of ophthalmic injuries. Most frequent causes of severe ophthalmic injuries resulted motor-vehicle accidents and work injuries, both with 11 patients, followed by fall, assault, and sport. In each patient, severe ocular injuries were associated with midface fractures with the involvement of one or more orbital walls. Severe reduction or loss of vision was due to one or a combination of the following mechanisms: direct lesion of the ocular globe (18 patients); indirect traumatic optic neuropathy (11 patients); direct traumatic optic neuropathy (3 patients); and orbital compartment syndrome due to a retrobulbar hematoma (8 patients). The 18 patients with direct lesions underwent combined maxillofacial-ophthalmologist interventions to repair ocular and facial fractures. Ten of these patients partially or totally recovered vision. In the other 22, ophthalmologists were not called and the surgeon administered NASCIS protocol with megadose steroids, and a drainage in those with retrobulbar hematoma was performed too. Sixteen of these patients partially or totally recovered vision Conclusions Severe ocular injuries can be encountered by craniomaxillofacial surgeon when called to assess a patient with facial fracures. Surgeons should be able to perform at least a rapid ophthalmic assessment and to evaluate the severity of the ophthalmic lesion. Visual acuity should be monitored for various hours, because a futher worsening can suggest an indirect traumatic optic neuropathy or a compartment syndrome. Then, together with the ophthalmologist, the treatment of ocular and skeletal lesions could be planned: some lesions can be treated before the repair of bone lesions, others can be simultaneously treated with facial reconstruction.