Current Concepts and Management of Severely Traumatized Ocular Adnexa and the Optic Nerve

Abstract

Trauma is responsible for 4.5 % of all orbital pathologies (Rootman 1988). Ocular trauma, especially penetrating wounds of the orbit, can cause several problems like monocular blindness (Sharma et al. 1994). The orbit is shaped like a horizontal pyramid, and penetrating objects are directed toward the apex and pass through the optic canal and superior orbital fissure, providing ready passage into the intracranial cavity. Hansen points out that the structural characteristics of the orbit play an important role in the pathogenesis of the intracranial extension of trauma (Amin et al. 1999; Hansen et al. 1988; Takeshi et al. 2001). Orbital trauma can damage soft tissues, embed foreign bodies, and cause fractures. Complications associated with orbitocranial injuries include infection (ocular infection, meningitis, meningoencephalitis, and brain abscess), traumatic arteriovenous fistula, intracranial hemorrhage, cerebrospinal fluid (CSF) leak, epileptic seizures, and loss of mental and motor function due to severe damage to the brain parenchyma (Grove 1977). Penetrating orbitocranial trauma is a potentially life-threatening injury. During the Second World War, 12 % mortality rate was found among the 42 cases of orbitocranial wound recorded by the authors (Brook 1987). Early diagnosis of brain injury from orbitocranial trauma may prevent serious neurological dysfunction (Solomon et al. 1993).