Ocular injuries in mid-facial fractures: A retrospective study

Abstract

Purpose: Mid-face injuries are usually accompanied with loss of integrity of the orbital skeleton along with the subsequent affection of the visual apparatus. This study aimed to highlight the incidence of different eye injuries associated with mid-facial fractures and to accentuate the need of the maxillofacial surgeon to comprehend and approach the post-traumatic ophthalmic consequences. Patients and methods: A total of twenty five patients suffering from mid-facial fractures and orbital involvement were included in this study from the departments of oral and maxillofacial surgery, faculties of Dentistry, Cairo University and MSA University. They were 22 males and 3 females with a mean age of 37 years. All the patients were subjected to immediate clinical and radiographic examination to evaluate the extent of the injury and its implications. An ophthalmologist was asked to further assess the eye apparatus to determine the exact ophthalmic complications. The collected clinical, radiographic and ophthalmic findings were recorded and analyzed. Results: A dominating etiology of Road Traffic Accidents was found (64%) with a significant male predominance (88%). Mid-face trauma in the form of ZMC fracture was acquainted as the most common reason for ophthalmic problems (36%) followed by the direct orbital blow-out fractures (20%). A wide range of ophthalmic complications were recorded. Sub-conjunctival hemorrhage (92%) was the most common to occur followed by peri-orbital edema (84%) and lid ecchymosis and laceration (76%). A clinical complaint from sensory infra-orbital nerve paresthesia was documented (72%). Diplopia (48%) and Enophthalmus (24%) were encountered as the most severe types of complications with other non-significant occurrence of reduced vision (8%), retinal detachment (4%), corneal problems (8%) and traumatic hyphema (8%). Conclusion: We concluded that it is a must to extend the maxillofacial surgeon's knowledge to include post-traumatic ocular injuries and their ophthalmic complications to complement an optimal patients' treatment outcome and to prevent disastrous ophthalmic repercussions following mid-face injuries.