Severe ocular trauma often associated with compromised airway, breathing, circulation
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WAILEA, Hawaii — In patients with traumatic periorbital and orbital injuries, airway, breathing and circulation – the ABCs – need to be addressed first, before addressing ocular trauma.
Particularly in an emergency room setting, patients with severe ocular injury often have airway compromise due to nasal and neck injuries, midfacial collapse, and oral or nasopharyngeal bleeding. Neurologic deficits and lacerations that affect breathing and circulation are also common in trauma cases, and all need to be “managed right away before addressing soft-tissue injuries or bony defects,” Hui Bae Harold Lee, MD, FACS, said at Hawaiian Eye 2021.
After securing the ABCs, “We start with understanding soft-tissue issues around the orbit,” he said.
Outside of sharp injury, such as dog bite, or projectile injury, it is rare for tissue to be missing.
“When it’s blunt trauma, a car accident or punches, those types of injuries, typically the soft tissue is all there, you just have to put it back together,” Lee said.
As a basic surgical principle for eyelid reconstruction, “You really want to avoid vertical retraction or vertical tightness,” Lee said.
Furthermore, Lee said he rarely uses a full-thickness graft in the emergent setting but creates a rotational flap to carry the blood vessel supply with it, because such traumatic injuries often involve major blood vessel supply of eyelid and adjacent structures.
“Almost always the tissue is there,” Lee said.
Guiding principles for eyelid repair are to align known anatomic landmarks, avoid vertical tension, lengthen vertical height, use rotational flaps, and place the lid on tension, he said.
“Finding these points, finding the lid margin, bringing tissue back together will result in far improved outcome and secondary healing,” he said. “All these patients tend to do better when you do it right the first time rather than doing it wrong two or three times.”
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Lee HBH. Catastrophe to trophy: Salvaging significant orbital injuries. Presented at: Hawaiian Eye; May 8-14, 2021; Wailea, Hawaii.
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