Background: Le Fort type III fractures can occur concurrently with optic canal fractures; in addition, multiple blows to the face can cause ocular trauma. Here we report the case of a patient with Le Fort type III fracture concurrent with optic canal fracture on one side and hypotony maculopathy on the contralateral side.
Case: A 43-year-old man lost consciousness after being repeatedly hit in the face with an iron pipe by a thug and was transported to the department of emergency and critical care. He was diagnosed with multiple facial bone fractures concurrent with Le Fort type III fracture and multiple brain contusions. After regaining consciousness, he exhibited bilaterally reduced visual acuity. On day 33 after injury, at consultation at the department of ophthalmology, he was diagnosed with bilateral traumatic optic neuropathy; however, no treatment was provided. Further, because there was no improvement in visual acuity, he was referred to the department of ophthalmology of our hospital on day 62 after injury. The visual acuity in the right and left eyes were 0.7 and 0.3, respectively. In addition, the values of intraocular pressure in the right and left eyes were 3 and 12 mmHg, respectively. Moreover, moderate mydriasis was observed in both eyes in addition to anisocoria. Furthermore, a relative afferent pupillary defect was observed in the left eye. We also noted a spoke-wheel fold on the right eye macula and pallor on the left optic disc. Further, the patient was diagnosed with right hypotony maculopathy and left optic canal fracture. An encircling procedure was performed for the right eye and optic canal decompression was performed for the left eye on days 69 and 90 after injury, respectively. Intraocular pressure of the right eye improved immediately after surgery, whereas visual acuity of the left eye recovered gradually. Approximately 1 year after injury, the visual acuity was 1.2 and 0.8 in the right and left eyes, respectively, and the intraocular pressure was 12 and 10 mmHg in the right and left eyes, respectively.
Conclusions: After polytrauma of the face, a bilateral injury to the pupillary sphincters may lead to the loss of pupillary light reflex. In cases of Le Fort type III fracture concurrent with bilateral visual impairment, it is important to perform ophthalmologic examinations considering ocular trauma and traumatic optic neuropathy, which can occur simultaneously in both eyes.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127: 850-858,2023.