Ophthalmic involvement in cranio-facial trauma

Objectives: This is a retrospective descriptive case study which will look into the spectrum of ophthalmic involvement in cases with orbital and eye i njuries after cranio-facial trauma and to analyse the visual and motility o utcome, Material: One hundred and four cases with ophthalmic involvement af ter cranio-facial trauma that were referred to and seen in the eye departme nt of a tertiary teaching hospital in Singapore between 1991-97 were includ ed in the study. Methods: The case records of 104 such patients were traced . The demographic data, the mode of injury, the type of fracture sustained and presence of serious eye injury were noted. The details about visual acu ity, significant diplopia and enophthalmos at the first and last visits wer e charted, Presence of traumatic optic neuropathy including the type of tre atment given was recorded. Results: There was a male preponderance (82%), T he industrial accidents were 21%, only next to road traffic accidents, whic h constituted approximately 36.5%, The predominant types of fractures seen were blow-out orbital fractures, complex fractures comprising of Le-Fort II , III, panfacial and fronto-basilar skull fractures. Diplopia was the most common presenting feature (40%) with visual acuity disturbance (23% having <6/60) as the next most common finding. Traumatic optic neuropathy was seen in 20% of patients and serious eye injury was present in 9% of patients. T he incidence of traumatic optic neuropathy was significantly higher (p < 0. 001) in patients with complex fractures and fronto-basilar fractures, as co mpared to the blow-out and zygomatico-maxillary fractures. Analysis of fina l results indicated 15% as having significant diplopia in one or more gazes and 12.5% as having a vision of <6/60, Conclusion: Diplopia and visual acu ity disturbances seem to be the most common ophthalmic presentations in cra nio-facial trauma. A significant number of patients suffer from poor vision and significant diplopia despite treatment. (C) 2000 European Association for Cranio-Maxillofacial Surgery.