Reversible Blindness Following Orbital Fracture Repair

Abstract

The authors report a case of a 72-year-old woman with unilateral, complete, reversible blindness (no light perception) immediately after uncomplicated repair of an orbital floor fracture. In this case, vision loss was reversed with prompt surgical intervention with removal of the orbital floor implant. The authors review the etiology of vision loss after orbital fracture repair and hypothesize as to the cause of blindness in this case. Given the frequency with which orbital fracture repair is performed by a variety of surgical subspecialists, it is imperative for surgeons to be familiar with the ophthalmic complications and be aware of the multiple causes of postoperative vision loss. The authors propose that immediate postoperative assessment of visual function be performed on all patients undergoing orbital fracture repair.

An Analysis of Medical Malpractice Litigation Involving Orbital Fractures

“…13 Direct optic nerve injury has been reported in 3.7% of cases on average. 13 In this study, 18 of 49 cases had preoperative formal ophthalmologic examination. Surgeons should discuss the potential of blindness with patients during the preoperative informed consent process 14 and be aware of the common causes of postoperative vision loss to decrease the chances of this complication occurring.…”

“…Blindness after orbital fracture repair is a rare complication and has been reported in 0.3% of cases 13 . Postoperative vision loss can be caused by retrobulbar hemorrhage, ischemic optic neuropathy, orbital emphysema, retinal arteriolar occlusion or spasm, direct optic nerve compression or stretching, and bone fragments impinging on the optic nerve 13 . Intraoperative causes include prolonged traction on orbital tissues, anemia and hypotension 13 .…”

“…13 In addition, improperly sized implants have also been implicated in optic nerve compression and subsequent blindness. 13 Direct optic nerve injury has been reported in 3.7% of cases on average. 13 In this study, 18 of 49 cases had preoperative formal ophthalmologic examination.…”

“…Since these are known complications, patients should be counseled on the potential for these complications with surgical intervention. Blindness after orbital fracture repair is a rare complication and has been reported in 0.3% of cases 13 . Postoperative vision loss can be caused by retrobulbar hemorrhage, ischemic optic neuropathy, orbital emphysema, retinal arteriolar occlusion or spasm, direct optic nerve compression or stretching, and bone fragments impinging on the optic nerve 13 .…”

Orbital floor fracture repair: the endonasal approach

“…By the time the patient is able to draw attention to the problem after awakening from anesthesia, it may already be too late to correct it. Cases of blindness have been reported (26,27) .…”