Comprehensive Reconstruction After Oculofacial Trauma

To describe the coordinated surgical management between different sections of an ophthalmologic service in ocular, palpebral and lacrimal reconstruction in polytraumatized patients

Ophthalmology Department, Hospital Clínico Universitario Virgen de la Arrixaca. Murcia, Spain.

60-year-old male with palpebral ptosis, constant epiphora and poor vision in the left eye since facial trauma due to a traffic accident 30 years ago.

On examination we found a visual acuity (VA) in his left eye of hand movement with a total inferior iridian defect and subluxation of traumatic cataract. In addition, he had an aponeurotic palpebral ptosis with cicatricial lagophthalmos and lower eyelid retraction. In the lacrimal duct we found a complete destructuring with absence of lacrimal puncta and lacrimal canaliculi and fractures of the medial wall of the orbit and nasal bones, which rejected reconstructive surgery.  

Given the impossibility of performing a dacryocystorhinostomy, the obstruction of the lacrimal duct was resolved by placing a 20 mm long Jones StopLoss tube by nasal endoscopic visualization, with satisfactory results. Surgery of the levator aponeurosis was performed with functional objective.

Subluxated cataract surgery was performed by lensectomy through pars plana and implantation of an Akreos Adapt AO lens sutured to the sclera with Goretex CV7. Inferior iridian defect was corrected by pupilloplasty.

After the intervention, the patient presented a VA with correction of 0.33, disappearance of epiphora that has been maintained until now (more than 1 year) without complications and appreciable aesthetic improvement.

In oculofacial trauma, the coordinated and sequential work of different ophthalmologic specialists is important to obtain a good esthetic and functional result.