Do patients with facial trauma to the orbito-zygomatic region also sustain significant ocular injuries?

A retrospective study of orbito-zygomatic injuries presenting to eye casualty over 3-year period revealed the majority of patients with pure orbital "blow-out' fractures had no other associated ocular abnormalities and 96% of these patients had a visual acuity of 6/9 or greater at discharge. In contrast only 74% of patients with multiple facial fractures had a visual acuity of 6/9 or greater at discharge. Severe ocular trauma was uncommon in patients with orbito-zygomatic injuries. Decrease in visual acuity was the main clinical finding accompanying significant eye injury. Early ophthalmic assessment is recommended in these cases to exclude potentially serious complications such as traumatic optic neuropathy. All patients with blow-out fractures managed conservatively had complete resolution of troublesome diplopia without extra-ocular muscle surgery.

The effectiveness of peri-operative cardiac monitoring and pulse oximetry.

Life-threatening systemic complications during ophthalmic surgery under local anaesthesia are rare. However, respiratory and cardiovascular complications can cause significant morbidity and mortality. In this study continuous peri-operative oxygen saturation and cardiac monitoring provided the surgeon with early warning of life-threatening complications, resulting in rapid intervention and full recovery of the patients. Pre-operative venous cannulation aided rapid treatment. Due to ease of handling and interpretation, the equipment can be used effectively for peri-operative monitoring without any specialist training. All patients should be carefully monitored during local anaesthesia with pulse oximetry and cardiac monitors.

Pattern of ophthalmological accidents and emergencies presenting to hospitals.

STUDY OBJECTIVE: To investigate the numbers and characteristics of patients with ophthalmological accidents and emergencies presenting to hospitals. DESIGN: Prospective survey over eight weeks. SETTING: Two general and one ophthalmic accident and emergency departments, two general outpatient departments, and an eye hospital ward consulting room (all in two teaching hospitals) in Newcastle upon Tyne. MEASUREMENTS AND MAIN RESULTS: Consultation numbers by age, sex, health district of residence, source of referral, diagnosis, and disposal were determined. An average of 37 ophthalmological emergency patients were seen daily. The all cause consultation rate per 1000 population for Newcastle residents was 2.64 (17.2 per year); for injuries it was 1.10 (7.2 per year) and for inflammations the rate was 0.91 (5.9 per year). Consultation rates per 1000 were 3.5 for males and 1.8 for females, the excess being explained by the higher risk of injury to men. Most patients were self-referred (58%), consulted during office hours (79.6%), were attended by senior house officers working alone (83.9%), and were asked to return for follow up (66.1%). Patients in an accident and emergency department seldom saw a consultant in their initial management. The diagnoses of patients from outside Newcastle were little different from those who lived within the city. The 10 commonest problems accounted for 68% of all cases. Injuries were the commonest problem (40.9% of all diagnoses). CONCLUSION: Ophthalmological accident and emergencies are an important component of an accident and emergency department workload. These patients are usually seen by junior doctors, some untrained in ophthalmology. The wide range of presenting problems poses a challenge for training and the organisation of effective referral chains, while the gender difference in injury rates points to the potential for prevention.