One doesn’t think of eye injuries when dealing with motor vehicle accidents; however, some patients do suffer maxillofacial trauma that ultimately affects the optic nerve or the orbit itself. Maxillofacial trauma involves fractures to the facial bones such as the maxilla, the mandible and orbital bones. Fractures that blow out the eye or cause the eye to sink into the maxillary sinus are particularly dangerous and can affect vision permanently. These fractures often happen when the face strikes a hard object in the car such as the steering wheel, the dashboard or the seat in front of a back seat passenger.
A research study was done to look into the incidence and prognosis of traumatic optic neuropathy in patients who suffer from maxillofacial trauma, which most of the time was due to motor vehicle accidents. Because of the rarity of this type of injury, only eight patients had been diagnosed with traumatic optic nerve neuropathy. The pool came from 354 cases of people with maxillofacial trauma who were diagnosed from December 2008 through May 2011. This was a retrospective study of these patient’s records.
They looked at the facts of the case, the findings on clinical exam and the CT findings on examination. The interventions and outcome were also looked at, especially to see if any of the patients recovered any of their vision. They noted that only 2 percent of all maxillofacial-injured patients actually suffered from some optic neuropathy and vision loss. The age range was from 21 years to 60 years. In 7 of the cases, the injury happened as a result of an automobile accident. One sustained his injury after surgery for a zygomaticomaxillary complex fracture. In fact, all patients who sustained vision loss due to optic neuropathy had zygomaticomaxillary complex fractures. One patient had what is called a Le Fort II fracture, one had a fracture of the mandible condyle and one had a ramus fracture. Two patients also had fractures of their cranial bones in some places.
Six patients received immediate corticosteroids to decrease the swelling of the optic nerve. As a result, one patient had improvement in his or her visual acuity. Two patients had decompression surgery to the eye and one of these showed improvement in visual acuity. Two other patients spontaneously recovered their vision after their fractures were treated. A total of four patients underwent open surgery with reduction of their fractures and fixation of the bony fragments in their maxillofacial fractures. One patient had no displacement of their fracture and did not need any surgical intervention. Three patients were offered surgery but refused any type of surgical intervention from surgeons.
The researchers concluded by saying that traumatic optic neuropathy was associated mostly with zygomaticomaxillary complex fractures, fractures of the cranial bone and Le Fort II fractures. If the patient suffered a loss of consciousness, he or she was likely to have an optic nerve injury. Those having an injury to the optic canal or to the supralateral aspect of the orbit were more likely to have bleeding in the area of the optic nerve and optic neuropathy as a secondary finding.