Abstract

Aim: Case study of 25 patients to understand the nature and type of orbital fractures and ocular complication in two wheeler drivers in road traffic accidents.

Methods: prospective study of 25 patients aged between 20-40years with history of road traffic accidents while driving two wheeler. Study was conducted over a period of one year from august 2018 to august2019 .patients with only orbital fractures were included in the study.

Detailed history, clinical examination of face, eye, and orbit was done .visual acuity was recorded, investigation like X-ray orbit and PNS, CT scan was taken at time of presentation and CT scan was repeated after 1month and 6month after the management of cases. Patients with Soft tissue injury without orbital fractures were managed medically by oral antibiotic and NSAIDS. Local moxifloxacin 0.5% eye ointment was used for skin abrasion and lacerated sutured wound.

Displaced comminuted lateral wall (zygoma) fractures were managed by open reduction with interfragment wire fixation or plate and screw fixation (ORIF). Orbital floor reconstruction was done using titanium mesh.  All patients had regular follow up at 1week, 1month, 3month and 6month after the management of cases.

Result: All the patient in our study fell in age group of 20-40years .with male preponderance, 19 were male patients. Commonest nature of injury was by direct collision of two wheeler with another vehicle.

24%(6)of patient had isolated lateral wall fracture, 8%(2) had isolated medial wall fracture, 8%(2) had isolated floor fracture, lateral wall fracture combined with other wall fracture was  maximum 60%(15).

All patients had periorbital ecchymosis, and subconjunctival hemorrhage. Lid laceration was noted in 10 patients were suturing was done with 8-0 silk.

Extra ocular muscle movement restriction was noted in 8 patients. Enophthalmos, diplopia and infraorbital anesthesia was noted in 2 patients who had severe orbital floor fracture which was corrected by surgery. 2 patient developed traumatic cataract after 2months for which small incision cataract surgery with posterior chamber intraocular lens implantation was done. 4 patients had vitreous hemorrhage which was managed medically.

In our study 80% of the patient had normal vision only20% had decreased vision. No one was blind.

Conclusion: In our study multiple orbital wall fracture was common 60%, followed by isolated lateral wall fracture 24%. lateral orbital wall fracture are most common in two wheeler drivers following road traffic accidents  because lateral orbital wall being most prominent orbital structure susceptible to direct impact after fall from two wheeler. Multiple orbital wall fracture was common in two wheeler driver without helmet.

Keywords: orbital wall fractures, maxillofacial injuries, ocular complications, road traffic accidents, two wheeler drivers, ORIF-open reduction with internal fixation.