Temporary blindness and ophthalmoplegia from nasal packing

Initial Management of Massive Oral Bleeding after Midfacial Fracture

“…15 In addition, anterior nasal packing for midfacial fracture with cerebrospinal fluid (CSF) rhinorrhea is controversial because intracranial pressure may be enhanced and infection may develop. 11 High-velocity comminuted naso-orbitoethmoid fractures are frequently associated with extensive bleeding from the ethmoid vessels together with anterior cranial base fractures.…”

Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 4: ‘Can the patient see?’ Timely diagnosis, dilemmas and pitfalls in the multiply injured, poorly responsive/unresponsive patient

“…Visual acuity testing is reported to be the most appropriate and useful clinical test to recognise and document early loss of vision, and ideally should be assessed and noted in all cases of facial trauma involving the orbits 22 , but this may not possible in the early stages of the patient's overall assessment. Documentation also allows future comparisons and facilitates early identification of impending threats to vision, some of which may be iatrogenic 34 . Visual assessment typically involves the progression of Snellen's chart (6/6 to 6/60), counting fingers, hand movement, light perception and no perception of light, until a positive response is elicited.…”

Pneumatic nasal catheters:

“…Several clinical studies have associated nasal packing in the treatment of epistaxis with a number of complications that range in severity from being an uncomfortable nuisance to causing a life-threatening hypoxia. (Giammanco and Binns, 1970;Slocum et al, 1976;Stemm, 1981;Issa and Sulivan, 1983;Barbour etai, 1984). Dissatisfaction with conventional nasal packing led to the development of pneumatic nasal catheters or balloons which it was hoped would be associated with increased efficacy and fewer disadvantages (Gottschalk, 1974;Steiner and Masing, 1976).…”