Ophthalmic Injuries following Zygomatic complex Fractures

Objectives: To describe the spectrum and incidence of ocular injuries after zygomatic complex fractures (ZCF) and the effect of surgical treatment on those findings.
Methods: The files of 75 consecutive patients (55 males and 20 females, mean age 42 years, range 9-98), who presented to the Sheba Medical Center with ZCF between 2010 – 2013, were reviewed. All patients were examined by an ophthalmologist for vision quality, ocular injuries (conjunctiva, eyelids, cornea, anterior chamber, iris, pupil, lens, macula, and retina), intraocular pressure, eye movements, diplopia and eye ball position. Patients were classified into 3 groups according to the severity of the bony injury class I: minor or no displacement; Class II: mild to moderate displacement; class III: lateral displacement with comminution. In addition, ocular findings in surgically treated patients were compared with nonsurgical treated.
Results: The most frequent cause of injury was a fall (38%), followed by an assault (25%) and a motor vehicle accident (18%). Forty one patients (54%) underwent surgical intervention. The majority of patients (75%) were presented with minor ophthalmic finding, such as eyelids injuries, subconjunctival hemorrhage, corneal abrasion and pupil dilatation. Major ophthalmic injuries, such as restriction in globe movement were noted in 14% of the patients, diplopia in 11% and enophthalmos in 9%. All of these patients, with the exception of one, were surgically treated. High severity bony injuries were significantly correlated with major ocular findings (P<0.05).
Restriction in globe movement was significantly improved after surgery (P<0.05) and there was no significant improvement in diplopia and enophthalmos after surgery.
Conclusions: Major ocular findings such as enophthalmos and restriction in globe movement are associated with severe zygomatic injuries.
In most of those cases surgical intervention is indicated.