Blindness after blow-out fracture repair

Blindness following uncomplicated repair of orbital blow-out fracture has been reported previously. Mechanisms that have been implicated in this devastating complication include direct intraoperative injury to the optic nerve, increased orbital pressure, retrobulbar hemorrhage, and bone spicule impingement on the optic nerve. Two additional cases of blindness following uneventful surgical repair of a blow-out fracture are described herein. The first patient had sustained severe blunt trauma to the forehead after discharge from the hospital. The computed tomography (CT) scan of his orbit suggested a swollen optic nerve, and he was thus assumed to have traumatic optic neuropathy secondary to postoperative blunt trauma to the forehead. The second patient had prolonged, severe orbital edema. The operated eye had been patched, and the patient took analgesics ad lib to control orbital pain. Intraoperative and postoperative measures to help prevent such complications are emphasized.