Mechanism and Emergency Management of Blast Eye/Orbital Injuries

Sabri T Shuker

Disclosures

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

In This Article

Avulsion of the Eye Globe

A 30-year-old patient sustained severe multiple maxillofacial, orbital and neck secondary blast injuries due to an artillery bomb explosion. Shell fragment entrance from the left maxilla, transmaxillary sinus led to fractured left side infra-orbital rim and floor settled in the retro-bulbar region. The left globe was avulsed, almost out of the orbital socket anterior to the eyelids, with obvious avulsion of the superior, inferior and lateral rectus muscles. The eyeball was hanging by a small attachment of medial rectus muscle. A severed optic nerve, with its free end lying within the orbit, and all the blood vessels in the region were cut and posteriorly blocked by pressure and possibly cauterized by the shell fragment thermal effect.

The eyeball was removed and the shell fragment delivered from the retro-bulbar region via a direct orbital approach. The eye socket packed with Vaseline gauze, and the fractured maxilla reduced to its position using direct intra-osseous wiring and upper arch bar for the upper jaw as well as exploration of the neck wound Figure 6.

Severe multiple facial shell fragments injuries; showing the avulsed left eyeball.

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