Orbital fractures in women due to sexual assault and domestic violence.

PURPOSE: Because domestic violence and sexual assault have a widespread societal and medical impact, this retrospective study was designed to determine the frequency of sexual assault and domestic violence as causes of orbital fractures in women. METHODS: The records of 54 consecutive patients with orbital fractures presenting to the Ophthalmic Plastic and Orbital Surgery service of Penn State University's Department of Ophthalmology were reviewed. The type of trauma resulting in each patient's orbital injury was identified. The frequency of orbital fractures resulting from sexual assault or domestic violence was determined. RESULTS: The study included 35 male and 19 female patients, ranging in age from 27 months to 63 years. Orbital fracture was the result of sexual assault or domestic violence in one third of the female patients, but no male patients. Motor vehicle accidents accounted for another 31.6 percent of orbital fractures in female patients. CONCLUSIONS: Based on this retrospective study, sexual assault and domestic violence are frequent causes of orbital fractures in women. Healthcare workers evaluating female patients with orbital fractures should have a high index of suspicion regarding sexual assault or domestic violence as a possible origin of the injury. A pointed but sensitive approach may be necessary to elicit this history from the patient.

Management of eyelid dog bites.

Eyelid dog bites are common facial injuries that occur frequently in children and often involve the lacrimal canaliculi. Even though the incidence of infection following repair of these lacerations is low, prophylactic antibiotics should be administered to all patients. Good function and appearance of repaired eyelid dog bites is achieved with appropriate surgical management. This article presents 2 cases and a retrospective review of 7 patients with eyelid dog bite injuries evaluated and treated between August 1989 and June 1994; 6 of 9 patients were children. The lacrimal drainage system was lacerated in 6 of 9 patients. All patients underwent surgical repair of their injuries and received antibiotics directed at common canine oral bacterial flora. The patients were followed for a minimum of 3 months postoperatively. There was only 1 case of facial wound infection. Good functional results were achieved in all patients.

Margins of safety in dacryocystorhinostomy.

We attempted to clarify the anatomic relationships of the lacrimal sac by performing standard orbital dissections to expose the lacrimal canaliculi, lacrimal sac, the ethmoid air cells, nasal septum, frontal sinuses, and the cribriform plate in five human cadaver heads; and then measuring the distance between the internal common punctum (ICP) and five key structures. The mean vector distance from the ICP to the anterior aspect of the cribriform plate was 25.1 +/- 2.95 mm. This measurement, along with the others, helps clarify osteotomy placement for dacryocystorhinostomy, so that, for example, cerebrospinal fluid leak can be prevented. Improved understanding of the anatomy of this region is also valuable in planning surgery for orbital and naso-orbital tumors, trauma, and congenital abnormalities.

Acute dacryocystitis secondary to exudative rhinitis.

This report describes the unusual occurrence of acute dacryocystitis secondary to exudative rhinitis. An 18-year-old man with no prior history of tearing or dacryocystitis presented with acute left dacryocystitis. Nasal mucosal edema, lymphoid hyperplasia, and exudate obstructed the ostium of his left nasolacrimal duct. The patient improved rapidly with systemic antibiotic and nasal decongestant drugs. Both the nasolacrimal duct obstruction and dacryocystitis resolved completely within 2 weeks. One year later, serology suggested Epstein-Barr virus as the cause of the rhinitis. Acute intranasal inflammation may obstruct the nasolacrimal duct with potential secondary dacryocystitis. This type of nasolacrimal duct obstruction resolves without sequelae when the rhinitis improves.