OPHTHALMIC INJURIES ASSOCIATED WITH FACIAL TRAUMA Roccia F, Boffano P, Guglielmi V, Bianchi FA, Zavattero E, Fea A, Gerbino G Head & Neck dpt. And Ophthalmology Institute, University of Turin, Torino, Italy Nothing to disclose

OBJECTIVE OF THE STUDY Ophthalmic injuries determining loss of visual function associated with facial fractures are rare. The aim of the study is to present our management of patients with severe ophthalmic injuries and facial fractures.

MATERIALS AND METHODS : 1779 patients with facial fractures Criteria of inclusion Rapid Ophthalmological Assessment (R.O.A) Partial or total loss of vision Preoperative CT scans

MATERIALS AND METHODS Data collected included: Age and gender Mechanism of injury Site of facial fractures Type of ocular injuries Treatment and outcome

RESULTS 40 patients (2,2%) presented partial-total loss of vision 32 M / 8 F (mean age 42 yy) Main causes: motor-vehicle accidents (MVA) and work injuries (both with 11 patients)

MECHANISMS OF FACIAL FRACTURES AND TYPE OF OPHTHALMIC INJURIES

FACIAL FRACTURES Pure orbital23 patients OZM12 patients NOE / LeFort 5 patients Orbital walls involved

RESULTS 18 patients: direct lesion of the eyeball 10 patients with globe rupture: 6 received retinal assessment, suturing of the globe, facial fractures treatment in the same session with no visual recovery 4 required enucleation

RESULTS 8 patient with anterior compartment lesion: 6 underwent intervention for facial fractures and later transferred to Ophthalmic Institute 2 transferred to Ophthalmic Institute All patients had complete/partial visual recovery of the vision.

RESULTS 11 patients with indirect traumatic optic neuropathy were administred megadose of steroids according to NASCIS II protocol within 24h from trauma. 9 of these patients had partial or complete recovery of vision

RESULTS 3 patients: direct traumatic optic neuropathy 2 with intracanalicular bony impingement of the optic nerve received surgical nerve decompression at 7 and 10 days after trauma 1 had traumatic avulsion of the eye No patients recovered vision

RESULTS 8 patients: retrobulbar hematoma 7 had orbital decompression within 24 h of the traumatic event + NASCIS II with partial/complete recovery 1 had orbital decompression after 48 h + NASCIS II with no recovery

CONCLUSIONS The maxillofacial surgeon may encounter severe ocular injuries associated with facial fractures. Therefore he must be able to perform a R.O.A., to evaluate the severity of ocular injuries and to request an early ophthalmological consultation.

SIGNIFICANCE OF THE FINDINGS The tight collaboration between maxillofacial surgeon and ophthalmologist allows successful treatment when an early diagnosis of ocular lesions associated with facial fractures is performed.