Delayed Orbital Decompression in cases of posttraumatic blindness

Introduction:

The onset of blindness following a midfacial-fracture is specified with an incidence between 0.3% and 3.2% in the relevant literature. Resistance against neurodegeneration during total ischaemia of the optic nerve of up to four hours has been described.

We would like to report to cases from our clinic.

Case 1: A 92-year-old woman with anticoagulant medication who fell at the nursing home, was admitted to the ER suffering from loss of orientation, exopthalmus with a fixed pupil and a fixed ocular bulb. The CT-scan showed a retrobulbar hematoma on the right side. A lateral canthotomy and transethmoidal orbital decompression were performed. After surgery the motility of the pupil and vision improved to the pretraumatic state. The period between the fall and surgery had been just over 4 hours.

Case 2: A 85-year-old man who fell down the stairs to the basement, presented himself with an exophthalmus on the right side with a fixed ocular bulb and subtotal loss of vision. A lateral canthotomy and transethmoidal as well as transmaxillary orbital decompression were performed. There was a 5-hour interval between the fall and definitive surgery. Vision also improved to the pretraumatic state.

Conclusion:

Retrobulbar hematoma with ensuing blindness should be treated with immediate lateral canthotomy and transethmoidal orbital decompression as an option of therapy – even if the timespan between accident with onset of blindness and defintive treatment exceeds 4 hours or more (up to 24h).

Publication History

Publication Date:
18 April 2018 (online)