Pathophysiological mechanisms of blindness in facial trauma: A review


Blindness is a serious complication that can occur after facial trauma and may represent the loss of one of the most useful senses in the human relationship with the world—the sight. This study aims to review the pathophysiology of blindness related to facial trauma in order to identify the mechanisms by which it develops and to recognize the signs and symptoms required to establish proper diagnosis and treatment. Blindness following facial trauma may occur due to mechanisms that involve injury to the eyeball, optic nerve and eyelids. The leading causes of blindness resulting from facial trauma, and which may be altered by medical interference, are related to retrobulbar hemorrhage and traumatic optic neuropathy, which require extremely rapid diagnosis and can be accomplished with the resources available in most trauma-based emergency services. The authors conclude that loss of vision tends to be irreversible in direct eyeball and optic nerve lesions, but can be prevented in retrobulbar hemorrhage and traumatic optic neuropathy. Eyeball and, especially, sight accuracy evaluation should be included in the initial care of trauma patients, so that the lesions that might lead to loss of vision are diagnosed and treated early.

Share and Cite:

Ribeiro, A. , Reis, A. , Ramalho, D. , Júnior, S. and Pinheiro, J. (2013) Pathophysiological mechanisms of blindness in facial trauma: A review. Open Journal of Stomatology, 3, 183-191. doi: 10.4236/ojst.2013.32032.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Alves, M.R., José, N.K., Prado-Júnior, J., Usuba, F.S., Onclinx, T.M. and Marantes, C.R. (1995) Ferimento perfurante ocular: 400 casos admitidos na clínica oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Arquivos Brasileiros de Oftalmologia, 58, 342-345 (in Portuguese).
[2] Voughan, D., Asbury, T. and Riordoun-Eva, P. (2003) Oftalmologia geral. 15th Edition, Atheneu, São Paulo (in Portuguese).
[3] Dados do Censo 2000—IBGE (2002) Instituto Brasileiro de geografia e estatística. IBGE, Rio de Janeiro (in Portuguese).
[4] Whitcher, J.P., Srinivasan, M. and Upadhyay, M.P. (2001) Corneal blindness: A global perspective. Bulletin of the World Health Organization, 79, 214-221.
[5] Brandt, M.T. and Haug, R.H. (2001) Traumatic hyphema: A comprehensive review. Journal of Oral and Maxillofacial Surgery, 59, 1462-1470. doi:10.1053/joms.2001.28284
[6] Lima, V., Burt, B., Leibovitch, I., Prabhakaran, V., Goldberg, R.A. and Selva, D. (2009) Orbital compartment syndrome: The ophthalmic surgical emergency. Survey of Ophthalmology, 54, 441-449. doi:10.1016/j.survophthal.2009.04.005
[7] Lindfield, D. and Das-Bhaumik, R. (2009) Emergency department management of penetrating eye injuries. International Emergency Nursing, 17, 155-160.
[8] Levin, L.A., Beck, R.W., Joseph, M.P., Seiff, S. and Kraker, R. (1999) The treatment of traumatic optic neuropathy: The international optic nerve trauma study. Ophthalmology, 106, 1268-1277. doi:10.1016/S0161-6420(99)00707-1
[9] Perry, M., Dancey, A., Mireskandari, K., Oakley, P., Davies, S. and Cameron, M. (2005) Emergency care in facial trauma—A maxillofacial and ophthalmic perspective. Injury, 36, 875-896. doi:10.1016/j.injury.2004.09.018
[10] Smerdon. D. (2000) Anatomy of the eye and orbit. Current Anaesthesia & Critical Care, 11, 286-292. doi:10.1054/cacc.2000.0296
[11] Jayaram, H. and Calder, I. (2004) Eye and orbit. Anaesthesia & Intensive Care Medicine, 5, 300-301. doi:10.1383/anes.5.9.300.49895
[12] Wichmann, W. and Muller-Forell, W. (2004) Anatomy of the visual system. European Journal of Radiology, 49, 8- 30. doi:10.1016/j.ejrad.2003.11.001
[13] Schor, P., Belfort Júnior, R. and Chamon, W. (2004) Oftalmologia. Manole, Baueri (in Portuguese).
[14] Plaper, R. (2006) Conhecendo o olho. Manole, Barueri (in Portuguese).
[15] Burkat, C.N. and Lemke, B.N. (2005) Anatomy of the orbit and its related structures. Otolaryngologic Clinics of North America, 38, 825-856. doi:10.1016/j.otc.2005.03.017
[16] Reymond, J., Kwiatkowski, J. and Wysocki, J. (2008) Clinical anatomy of the superior orbital fissure and orbital apex. Journal of Cranio-Maxillofacial Surgery, 36, 346-353. doi:10.1016/j.jcms.2008.02.004
[17] Ansari, M.H. (2005) Blindness after facial fractures: A 19-year retrospective study. Journal of Oral and Maxillofacial Surgery, 63, 229-237. doi:10.1016/j.joms.2004.05.221
[18] Perunovic, B., Quilty, R.D., Athanasiou, A. and Love, S. (2001) Damage to intracranial optic pathways in fatal closed head injury in man. Journal of the Neurological Sciences, 185, 55-62. doi:10.1016/S0022-510X(01)00463-4
[19] Turbin, R.E., Maxwell, D.N., Langer, P.D., et al. (2006) Patterns of transorbital intracranial injury: A review and comparison of occult and non-occult cases. Survey of Ophthalmology, 51, 449-460. doi:10.1016/j.survophthal.2006.06.008
[20] Entezari, M., Rabei, H.M., Badalabadi, M.M. and Mohebbi, M. (2006) Visual outcome and ocular survival in open-globe injuries. Injury, 37, 633-637. doi:10.1016/j.injury.2006.02.043
[21] Chen, C., Selva, D., Floreani, S. and Wormald, P.J. (2006) Endoscopic optic nerve decompression for traumatic optic neuropathy: An alternative. Otolaryngology—Head and Neck Surgery, 135, 155-157. doi:10.1016/j.otohns.2005.03.056
[22] Gerbino, G., Ramieri, G.A. and Nasi, A. (2005) Diagnosis and treatment of retrobulbar haematomas following blunt orbital trauma: A description of eight cases. International Journal of Oral and Maxillofacial Surgery, 34, 127-131. doi:10.1016/j.ijom.2004.05.001
[23] Perry, M. (2008) Acute proptosis in trauma: Retrobulbar hemorrhage or orbital compartment syndrome-does it really matter. International Journal of Oral and Maxillofacial Surgery, 66, 1913-1920. doi:10.1016/j.joms.2008.04.012
[24] Hislop, W.S., Dutton, G.N. and Douglas, P.S. (1996) Treatment of retrobulbar haemorrhage in accident and emergency departments. British Journal of Oral and Maxillofacial Surgery, 34, 289-292. doi:10.1016/S0266-4356(96)90004-2

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.