Citation

McClenaghan FC, Ezra DG, Holmes SB. Curr. Opin. Ophthalmol. 2011; 22(5): 426-431.

Affiliation

aOral and Maxillofacial Department, Bart's and the London NHS Foundation Trust bAdnexal Department, Moorfields Eye Hospital NHS Foundation Trust cDepartment of Cell Biology, UCL Institute of Ophthalmology dMoorfields Eye Hospital and UCL Institute of Ophthalmology, NIHR Biomedical Research Centre for Ophthalmology, London, UK.

Copyright

(Copyright © 2011, Lippincott Williams and Wilkins)

DOI

10.1097/ICU.0b013e3283499420

PMID

21730843

Abstract

PURPOSE OF REVIEW: To examine the proposed mechanisms of vision-threatening injuries occurring secondary to orbital and facial trauma: traumatic optic neuropathy (TON), retrobulbar haemorrhage (RBH) and penetrating eye injury. To evaluate the evidence supporting different management options for traumatic vision-threatening injury. RECENT FINDINGS: Despite considerable debate over the roles of surgical decompression and systemic steroid therapy for TON, these interventions have not been proved to be more effective than conservative management and there is limited evidence that the use of steroids may be associated with an adverse outcome. Lateral canthotomy and inferior cantholysis have been proven to be effective treatments for RBH. Orbital exploration and surgical evacuation of haematoma remains a second line intervention. Open globe injuries require immediate primary surgical exploration and repair. Irretrievable devastating globe injuries require either enucleation or evisceration. There is no consensus as to which is the best treatment with recent surveys indicating that enucleation is preferred in the USA and evisceration in the United Kingdom. SUMMARY: Conservative management is the first line treatment for TON. The evidence strongly supports lateral canthotomy and inferior cantholysis as best treatment for RBH. There is no consensus as to whether enucleation or evisceration is the best treatment for irretrievable devastating globe injury. The choice of management is currently determined by surgeon preference.

Language: en