Blindness, Vision Loss Linked With Maxillofacial Fractures

Woman with bruised eye and sterile strips on forehead
Face of mature woman with bruised eye and sterile strips on forehead covering many stiches.
Report: Zygomaticomaxillary complex fractures come with high risk of other ocular injuries.

Zygomaticomaxillary complex fractures have a high risk for associated ocular injuries, according to research published in the Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology.  

Because maxillofacial fractures are frequently associated with ocular injury, researchers conducted an analytical cross-sectional study of patients referred to a single center in Iran for maxillofacial trauma to clarify the relationship between these injuries and poor ocular outcomes. 

Patients referred between March 2019 and February 2020 with maxillofacial fractures were included in the study. Investigators collected demographic variables like age, sex, and trauma etiology. Fracture type was determined by a maxillofacial surgeon and based on radiographic data. Fractures were categorized as frontal, nasoorbitoethmoid (NOE), zygomaticomaxillary complex (ZMC), Lefort I, II, or III, mandible, or nasal. Orbital fractures were further categorized as superior rim, inferior rim, walls, roof, or orbit floor fractures. 

Ocular injuries were categorized as globe rupture, periorbital edema (POE), subconjunctival hemorrhage (SCH), limitation of movement (LOM), optic nerve injury, exenteration, redness, or blurred vision injury. 

A total of 174 patients were included in the study (mean age, 31.3±12.35 years; 86.8% men). A total of 63.2% of patients experienced various ocular injuries, while the remaining 36.8% had no ocular injuries or visual impairment

The most frequent fracture etiology was motor vehicle accidents, which accounted for 80.5% of cases. 

A total of 259 fractures in 174 patients were recorded. The most frequent was mandible fracture (51.7%) followed by ZMC fracture (51.1%). A frontal fracture pattern was significantly correlated with NOE and nasal fractures. NOE fractures also had a significant correlation with Lefort and mandible fractures. Conversely, mandible fractures had a negative correlation with ZMC and nasal fractures. 

Among 98 orbital fractures, the most common were inferior and superior rim fractures (28.1% and 23.5%, respectively). The study shows a significant correlation between inferior with superior rim fractures and orbital floor fractures. It also shows wall fractures significantly correlated with superior rim, roof, and floor fractures. 

The most frequent injury across the recorded ocular injuries was POE, observed in 50.5% of cases. 

Study limitations include the small sample size and unforeseen events such as death or premature discharge which may have excluded patients with more severe injuries.

“Maxillofacial fractures are usually associated with ocular injuries, leading to loss of vision and blindness,” the research concludes. “A comprehensive evaluation of different fracture patterns may help surgeons and clinicians to diagnose better and risk estimation.” 


Dalband M, Kazemi KS, Shahriari M, Amirzade-Iranaq MH. Ocular injury, visual impairment, and blindness associated with maxillofacial trauma. J Oral Maxillofac Surg Med Pathol. Published online September 10, 2021. doi:10.1016/j.ajoms.2021.08.005