Ocular trauma in mid face fractures - An interdisciplinary approach

Abstract

Purpose : This prospective study was done to evaluate the ophthalmic injuries sustained in mid-face trauma and to emphasize the need for understanding the ophthalmic signs and symptoms at the time of presentation. Methods: A total number of 68 patients presenting to our tertiary care centre with mid-face fractures, clinically and radiographically proven, and who underwent complete ophthalmological evaluation at the time of initial presentation were considered in the study from July 2016 to May 2017. Ophthalmology referral was done to determine the exact nature of injury and its implications. The ophthalmic injuries were then correlated with the type of fracture. Results: The patients were predominantly male with an average age of 33 years. Facial trauma was found more due to road traffic accidents. The most common type of mid-face fracture seen was zygomatico-maxillary complex fracture. Most of the ophthalmic injuries in our study were mild in severity accounting for 67.5% of the cases. Around 27.3% of the injuries were moderate in severity and only 5.19% of the injuries were severe. Forty-six of the 68 patients exhibited sub-conjunctival haemorrhage (67.65 %). Thirty nine patients displayed periorbital oedema (57.35 %), eight patients experienced diplopia(11.76%), one case each of retrobulbar haemorrhage, optic nerve compression and traumatic optic neuropathy (1.45%). Twelve patients presented with infraorbital nerve paraesthesia which was predominantly associated with the zygomatico-maxillary complex fractures. Conclusion: Ophthalmic injuries might not affect the surgical treatment plan of mid-face fractures, but they definitely influence the timing of surgery, as certain injuries need immediate ophthalmic intervention to avoid potential blinding complications. Zygomatico-maxillary complex fractures and panfacial fractures were associated with an increased occurrence of ocular injuries. To obtain a more conclusive and comprehensive evaluation an interdisciplinary approach including both the maxillofacial surgeon and the ophthalmologist is required.

Keywords

• Ocular trauma
• ZMC fractures
• mid-face injury

References

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