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Pattern and Significance of Ocular Injuries Associated with Orbito- Zy- gomatic Fractures

 Hassan Albeshri

Introduction: The face, orbit, and eyes have a rela- tively prominent position in the human body mak- ing this area more susceptible to trauma. A variety   of ophthalmic injuries associated with mid-facial   fractures has been reported in the literature [1]. Mo- tor-vehicle accidents, as sault, falling down injuries,   occupational, and sport accidents are generally con- sidered as common etiologies of maxillofacial frac- tures [2].   Zygomatic fractures are the most common facial fractures second only to nasal fractures and these   fractures are also the most commonly occurring frac- tures of the orbit [3]. There is a recognized associ- ation between orbitozygomatic fractures and ocular   injuries. The reported incidence of ocular injuries in patients with orbital fractures varies widely, ranging from 2.7% to 90% [1,4]. Al-Qurainy et al. developed   criteria for appropriate referral to an ophthalmolo- gist. The authors proposed the acronym “BAD ACT,”   to represent Blowout, Acuity, Diplopia, Amnesia, and Comminuted Trauma, as a method for easy recall.   However, the system is not commonly used in clini- cal practice [5]. The severity of an injury is related to   the site of the fracture and direction of the incom- ing force. The outcome may range from mild injury   such as sub-conjunctival hemorrhage (SCH) to severe damage like globe rupture or permanent visual loss [1,4].   Early diagnosis of potentially serious ophthalmic in- juries is paramount not only in minimizing long-term   complications of midfacial fractures but also from a medico-legal standpoint. The management of the ophthalmic injuries must be considered as the first priority. Repairing the fractures before treatment of   ophthalmic injuries may further compromise visual outcomes, leading to visual loss [5]. Patients and Methods: This is a retrospective study of patients presenting with orbitozygomatic bone   fractures admitted to Maxillofacial Surgery Depart- ment at King Fahad Hospital in Almadinah Almun- awara, Saudi Arabia from 2012 to 2017. Patients with   isolated zygomatic arch fractures or concomitant midfacial fractures were excluded from the study. Fractures were diagnosed clinically. The extent of the   bony injury was confirmed with computerized tomo- graphic scans (CT). Patient demographics, date of   injury, date of presentation to the hospital, fracture etiology, brain injuries status and clinical ocular signs were recorded. All patients were examined by the ophthalmologist preoperatively, and if needed were also followed up postoperatively. On the basis of clinical examination and pre-treatment, radiograph/CT scan result, the study population was divided into 3 subgroups based on the extent of the bony injury. Results: The study population included 156 patients   (142 male and 14 female). There was a peak in inci- dence for adult compared to female accounting for   91% of the fractures as shown in Table 1.   Road traffic accident was the most commonly docu- mented mechanism of injury, accounting for 79.5%   (n=124) of the fractures, followed by fall down in- juries (18%, n=11.5), explosion (0.6%, n=1), assault   (4.5%, n=7), and gunshot (0.6%, n=1). This is summa- rized in Table 2.