Mechanism and Emergency Management of Blast Eye/Orbital Injuries

Sabri T Shuker

Disclosures

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

In This Article

Child Mine Ocular Blast Injury

A 3-year-old child sustained left orbital injury due to a small plastic mine explosion Figure 9. There was a total loss of his left eye/orbital tissue and comminuted fractures of almost all the orbital walls, as well as severe burn to the regional tissue and severe lower extremities injuries. The general condition of the patient was stable.

Totally avulsed ocular–orbital tissue due to mine explosion. (A) 3-year-old child sustained left eye/orbital injury due to small plastic mine. (B) Fractured superior orbital rim and no orbital anatomical tissue content left in orbital socket, as well as the burned cercum–orbital soft tissue. (C) Two months' postoperatively revealed healthy healing in the region.

Under general anesthesia, orbital cavity debridement was carried out, as all the soft orbital tissue including the eyeball was lost and the bone was denuded, smoked covered by burned necrotic tissue, which was removed. Curates and periosteum elevator was used to curettage the unhealthy soft tissue. The unhealthy bone was either nibbled or decorticated using round burs deep enough until the healthy bone was reached. Fractured supra-orbital rim reduction was carried out using intra-osseous stainless steel wiring. No local or distant flaps were used immediately to cover the denuded bone. The orbital cavity was packed with iodoform gauze saturated with iodoform paste and was changed every 4–5 days. This was continued until secondary intention granulation tissue healing took place as a healthy socket especially in exposed fragmented orbital walls bone. After healthy granulation tissue filled the eye socket, local flaps from the cheek's healthy tissue infraorbital region were utilized for reconstruction.

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