Mechanism and Emergency Management of Blast Eye/Orbital Injuries

Sabri T Shuker

Disclosures

Expert Rev Ophthalmol. 2008;3(2):229-246. 

In This Article

Ruptured Eyeball (Dark Uveal)

A patient of 32 years of age sustained a shell fragment injury that led to a severe left eye devastation injury. The shell entered right medial orbital wall and exited from the left orbit, causing a ruptured eye and mutilation to the left medial orbital wall in which the intercanthal space was left apart, as well as laceration of the eye lid. More small penetrating shell fragments peppered the face and upper arms, but no major injuries were observed. The patient's general condition was good.

On clinical examination, the left eye showed dark uveal tissue filling the eye socket, and an intercanthal space about 5 cm wide due to severe destruction of the left medial orbital wall and no bone segment canthal ligament attachments left in the region; there was no sign of rhinorrhea.

Under general anesthesia via oral intubation, wound debrediment was carried out using normal saline. The ophthalmologist carried out enucleation of the tethered eye tissue. Reconstruction of the NOE fractures were carried out, using intra nasal stabilization portex tracheotomy tubes, as described in the previous case as a parabolic arc scaffold. The canthal ligament was explored and because fine stainless steel wires were unavailable at the time of surgery due to exhausted resources as a result of a mass casualty situation, nylon silk was used to approximate the canthal ligament to an acceptable position. Two tracheotomy portex tubes wings were used after trimming to right shape as splint plates to secure the NOE region since lead buttons were unavailable. The portex tubes were left in position intranasally for 1 month. The patient had an uneventful recovery Figure 4.

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