A systems approach to the diagnosis and management of vision‑threatening ocular changes in midface trauma: a narrative review and proposed practical framework.

PURPOSE: To summarize current evidence regarding vision-threatening ocular complications associated with midface trauma and to propose a practical systems-oriented framework for their early recognition, evaluation, and management.

METHODS

A narrative review of the literature was conducted focusing on ocular injuries associated with midface trauma, including orbital compartment syndrome, open-globe injury, extraocular muscle entrapment, hyphema, posterior segment trauma, and traumatic optic neuropathy. Evidence was synthesized to develop a clinically applicable framework for multidisciplinary trauma care.

RESULTS

Vision-threatening ocular injuries following midface trauma require rapid identification and timely escalation. Key components include bedside ocular screening, recognition of red-flag findings, appropriate imaging, early ophthalmology consultation, and coordinated communication between emergency, maxillofacial, ophthalmology, and trauma teams. Evidence strongly supports urgent intervention for orbital compartment syndrome and does not support routine high-dose corticosteroid therapy for traumatic optic neuropathy. Additional recommendations include standardized checklists, structured handover processes, and local quality-improvement measures.

CONCLUSIONS

A systems-based approach may improve the early detection and management of vision-threatening ocular injuries in patients with midface trauma. The proposed framework aims to reduce preventable visual loss, standardize multidisciplinary care pathways, and support future prospective evaluation of clinical outcomes.