Blindness and visual impairment from severe midface trauma in Nigerians

Reports have shown that severe midface trauma causes blindness and visual impairment but information from sub-Saharan Africa is sparse. A retrospective analysis was carried out of patients who sustained trauma to the midface and subsequently lost vision in one or both eyes. There were 25 males and 7 females whose ages ranged from 5 to 65 years (mean +/- SD, 33 +/- 13.3 years). All patients presented between 1 h and 7 days of sustaining injury (mean +/- SD, 1.9 +/- 1.9 days). Road traffic accidents (37.5%) and gunshot injuries (34.4%) were the commonest causes. Of the 32 patients identified with loss of vision, half sustained fractures of the zygomatic complex while a total of 54 soft-tissue and bony injuries were recorded. The majority of patients (68.8%) had a ruptured globe, followed by vitreoretinal haemorrhage and traumatic optic neuropathy in 18.7% and 12.5%, respectively. Visual acuity ranged from 6/60 to 'no light perception'. Surgical exploration, enucleation, evisceration or exenteration was the treatment method used for those with ruptured globes. About 10.8% of patients with severe midface trauma also sustained loss of vision in one eye. Loss of vision associated with severe midface trauma is most likely to occur with road traffic accidents and gunshot injuries. High impact from such incidents often causes extensive damage to the eyeball resulting in immediate and irreversible blindness.