Ocular injuries in midfacial fractures.

The incidence of ocular lesions in midfacial fractures ranges from 4 to 67%, depending on the criteria used in the previous examination. We report a retrospective study of 219 patients (233 fractures) who were admitted to our hospital between January 1990 and June 1994. The fractures are classified according to Henderson's classification (X-ray and Computed Tomography). We present the results of the ophthalmologic evaluation, after excluding palpebral lesions, and discuss the correlation with the etiology and the kind of fracture. The ocular lesions are divided into extraocular and intraocular ones. The extraocular lesions that we found are the following: damage to the lacrimal system, cranial nerve damage, displacement of the eye, corneal erosion and corneal foreign body and conjunctival lesions (subconjunctival hemorrhages, lacerations and chemosis). The intraocular lesions studied are divided into lesions of the anterior structures (hyphema, traumatic cataract, lens dislocation and hernia of the iris) and lesions of the posterior structures (vitreous and macular hemorrhage, eyeball perforation, optic nerve damage and Berlin's edema). Our conclusion is that comminuted fractures, fractures of the orbital rim only and those of the orbital floor are the most frequently associated with ocular damage, being mainly caused by automobile accidents and assaults.