Visual loss due to orbital fracture. The role of early reduction

Serious injury to the optic nerve is an uncommon, usually permanent, complication of orbital fractures. Occasionally it is due to reversible changes, such as edema, contusion, or compression of the optic nerve. The early management of visual loss due to orbital fracture is controversial. Some authors advocate emergency optic nerve decompression; others recommend steroid therapy alone. We present a case of nearly complete unilateral loss of vision after a lateral orbital fracture with compression of the optic nerve by bony fragments. Computed tomographic scanning of the orbit helped us to pinpoint the cause of visual compromise and also served as a guide in planning surgery. Large dosages of steroids, combined with early reduction of the fracture, resulted in substantial recovery of vision. This case illustrates the importance of precisely determining the nature of the injury and the cause of visual compromise. A protocol for management of these injuries is presented.