Mechanism and Emergency Management of Blast Eye/Orbital Injuries

Sabri T Shuker

Disclosures

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

In This Article

Orbital Emphysema Subsequent to Blast

A patient was received in the maxillofacial department with cyanosis of his lips, nails and paler cold skin and dyspnoea due to oropharyngeal emphysema. The patient's family claim that the patient was exposed to an explosion that took place in a room close to the victim's room.

Owing to the patient's serious general condition and breathing difficulties, an emergency trechaostomy was decided upon and performed. Air bubbles started escaping from the surrounding subcutaneous tissue of the neck tracheostomy wound as well as from deep neck anatomical spaces in which decompression occurred. Facial emphysema was deflated subcutaneously using a large hypodermic needle, as well as eyelids emphysema deflated by a few pricks by large hypodermic needle.

The orbital emphysema decompression was attained by performing a small orbitotomy via lateral orbital rim small incision on zygomatico-frontal suture region and dissecting, carefully, the periosteom from the lateral wall to avoid traumatizing the eyeball by blunt dissection. The scissors were advanced posteromedially behind the globe, with closed tips to prevent inadvertent injury. The tips were spread gently, creating a small opening in periosteom, which was enough to allow the air bubbles out. Retrobulbar and orbital blast emphysema management is easier than hematoma and hemorrhage in the retrobulbar region. Once air under pressure is released, its effect on the blood supply will decrease. The patient had an uneventful recovery without optic nerve changes. Orbital canthotomy or inferior cantholysis could be the alternative when the pressure tension is high and expected to last longer Figure 8.

Cervico-facial subcutaneous and orbital emphysema subsequent to blast injury and management. (A) Severe emphysema to the cervical region anterior and posterior neck and face due to primary blast injury. (B & C) Severe subcutaneous and circum orbital soft tissue emphysema as well as the parotid gland region. (D) Uneventful recovery 10 days postoperatively.

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