Ophthalmological Evaluation by a Maxillofacial Surgeon and an Ophthalmologist in Assessing the Damage to the Orbital Contents in Midfacial Fractures: A Prospective Study

Abstract

Background and purpose Midfacial fractures may often be associated with injuries to the orbit which may lead to notable dysfunction of the visual apparatus, if not detected early after injury. The purpose of this study is to evaluate the associated ophthalmic injuries in mid-face trauma and to emphasize the need for understanding the ophthalmic signs and symptoms by an attending maxillofacial surgeon. Patients and methods A total number of 60 clinically and radiographically proven subjects with midfacial fractures were considered in the study that underwent complete ophthalmological evaluation at initial presentation. Referral to ophthalmologist was considered to determine the exact nature of injury and its implications. Results by a maxillofacial surgeon and ophthalmologist were evaluated. Results In our study, a male predominance with a mean age of 32 years was observed, with the most common etiology being Road Traffic Accidents. Forty-two of the 60 patients exhibited sub-conjunctival hemorrhage accounting for 70 % of ocular injuries recorded. While 28 of the 60 patients displayed peri-orbital edema (53.3 %), 8 patients experienced diplopia (13.32 %) and 8 patients showed relative afferent pupillary defect (13.32 %). Conclusion From our study, it becomes imperative that the maxillofacial surgeon should have a thorough knowledge of the various ophthalmic injuries that could occur in association with midfacial trauma in order to prevent visual complications to the patient. Understanding of the subtle injuries to the ocular apparatus which may be undiagnosed by a maxillofacial surgeon but have significant grave outcomes is essential.

Ocular injuries in mid-facial fractures: A retrospective study

“…A male predominance of 88% was found with a high incidence cause of Road Traffic Accidents (64%). This came in accordance with Patil et al (3) and nabeela et al (9) , which was normal considering the fact that a higher number of males are driving the vehicles than females. The second highest recognized cause was the inter-personal violence (36%); comparable to what was declared by Roccia et al (10) .…”

“…A high incidence of peri-orbital edema or hematoma (84%) and lid ecchymosis and laceration (76%) was recorded, comparable to all studies, which was normal to find due to the loose connective tissue around the eye. They are the first signs of trauma which in turn made the clinical examination difficult (3,11) .…”

“…The eye apparatus responsible for a vital role; vision, is naturally protected by the hard bony orbital rim and the soft orbital fat and muscles (3) . Despite this dual protection system, mid-face injuries accommodate for 68-95% ocular injuries with associated ophthalmic complications accounting for 19 million blind or reduced vision people worldwide (4) .…”

Development and validation of a multiple‐choice questionnaire‐based theoretical test in direct ophthalmoscopy

“…; Patil et al. ). Proficiency in the skill is expected of all young medical graduates (International Task Force on Ophthalmic Education of Medical Students ).…”

A Clinical Study of the Evaluation and Assessment of the Etiology and Patterns of Ocular Injuries in Midfacial Trauma in a Tertiary Care Hospital

“…Ocular injuries often accompany midface injuries. All facial trauma injuries, particularly above the level of the mouth, require a careful ophthalmic examination [4].…”