Clinical and X-ray features of combat orbital trauma with post-traumatic eye loss
DOI:
https://doi.org/10.31288/Ukr.j.ophthalmol.202644955Keywords:
maxillofacial trauma, gunshot injuries, orbital fracture, eyelid injuries, anophthalmia, CAD/CAM, combat trauma, soft-tissue injuriesAbstract
Purpose. To determine the clinical and X-ray features of combat orbital trauma with post-traumatic loss of the eye. Particularly, special consideration was given to the type and location of injuries of the bones of the orbit and adjacent structures, change in the bony orbital volume, and status of periorbital soft-tissue structures.
Material and Methods. We retrospectively reviewed medical records of 52 patients (69 affected orbits) aged 22 to 69 years who underwent treatment for orbital wounds at the Department of Maxillofacial Surgery, Bogomolets National Medical University, in 2022-2026. A commercial software package [Mimics Innovation Suite (Materialise NV, Leuven, Belgium)] was used to develop models of the affected and unaffected orbits and calculate the volumes of these orbits. Orbital fractures were classified into five categories according to Jaquiéry.
Results. Orbital fractures of Jaquiéry categories IV and V were most common among study patients. The mean volume of the traumatized orbit was 33.57 cm3 [median, 32.1 cm3; interquartile range, 29.5-36.4 cm3]. Of the 69 affected orbits, 36 (52.2%) had isolated orbital wall defects. Of the 52 patients, 16 (30.8%) had isolated lower-lid defects, and 26 (50.0%) had combined eyelid deformities, which constituted the majority of periorbital soft-tissue injuries. The eye was removed by evisceration due to severe eye trauma in 38 (73.1%) of the 52 patients.
Conclusion: Combat wounds of the orbit vary widely in the nature and extent of the traumatic process, from isolated orbital wall fractures and eyelid defects and deformities, to massive complex wounds with multifragmented fractures, defects in bony structures and soft tissues, and extensive soft-tissue damage and cicatrization. The bony orbital volume of the affected orbits tended to change depending on the involvement of adjacent structures and the type of the fracture.
References
Prysiazhniuk O, Palyvoda R, Chepurnyi Y, Pavlychuk T, Chernogorskyi D, Fedirko I, et al. War-related maxillofacial injuries in Ukraine: a retrospective multicenter study. Arch Craniofac Surg. 2025 Apr;26(2):51-58. https://doi.org/10.7181/acfs.2024.0074
Hale RG, Lew T, Wenke JC. Craniomaxillofacial battle injuries: injury patterns, conventional treatment limitations and direction of future research. Singapore Dent J. 2010 Jun;31(1):1-8.https://doi.org/10.1016/S0377-5291(12)70002-0
Palyvoda R, Kaniura O, Vares Ya, Fedirko I, Uhryn M, Chepurnyi Yu, Maxillofacial Surgery in Ukraine During a War: Challenges and Perspectives-A National Survey. Mil Med. 2024 Aug 30;189(9-10):1968-1975. https://doi.org/10.1093/milmed/usad465
Bahouth H, Ghantous Y, Rachmiel A, Amodi O, Abu-Elnaaj I. Maxillofacial Injuries Related to the Syrian War in the Civilian Population. J Oral Maxillofac Surg. 2017 May;75(5):995-1003.https://doi.org/10.1016/j.joms.2017.01.007
Thach AB, Johnson AJ, Carroll RB, Huchun A, Ainbinder DJ, et al. Severe eye injuries in the war in Iraq, 2003-2005. Ophthalmology. 2008 Feb;115(2):377-82.https://doi.org/10.1016/j.ophtha.2007.04.032
Penitente PA, Freitas da Silva EV, Pontes Manicoba LL, Azevedo Romero GD, Micheline Dos Santos D, Goiato MC. Prevalence of anophthalmia etiological factors in patients treated in a reference center: A retrospective study. Med J Armed Forces India. 2023 Sep-Oct;79(5):547-550. https://doi.org/10.1016/j.mjafi.2021.06.025
Janković S, Zuljan I, Sapunar D, Buća A, Pleština-Borjan I. Clinical and Radiological Management of Wartime Eye and Orbit Injuries, Military Medicine, Volume 163, Issue 6, June 1998, Pages 423-426, https://doi.org/10.1093/milmed/163.6.423
Jonak K, Matysiak M, Choragiewicz T, Nowakowska D, Zimenkovsky A, Shybinskyi V, et al. War-related eye trauma: a study of civilian and military cases from Ukraine's ongoing conflict. Front Public Health. 2025 Feb 10;13:1489445. https://doi.org/10.3389/fpubh.2025.1489445
MacKinnon CA, David DJ, Cooter RD. Blindness and severe visual impairment in facial fractures: an 11 year review. Br J Plast Surg. 2002 Jan;55(1):1-7. doi: 10.1054/bjps.2001.3728.https://doi.org/10.1054/bjps.2001.3728
Shere JL, Boole JR, Holtel MR, Amoroso PJ. An analysis of 3599 midfacial and 1141 orbital blowout fractures among 4426 United States Army Soldiers, 1980-2000. Otolaryngol Head Neck Surg. 2004 Feb;130(2):164-70. https://doi.org/10.1016/j.otohns.2003.09.018
Béogo R, Coulibaly TA, Dolo MT, Traoré I, Ouattara B, Diallo JW. Facial Fracture-Associated Blindness. J Craniofac Surg. 2018 May;29(3):751-753.https://doi.org/10.1097/SCS.0000000000004378
Kesterke MJ, Raffensperger ZD, Heike CL. et al. Using the 3D Facial Norms Database to investigate craniofacial sexual dimorphism in healthy children, adolescents, and adults. Biol Sex Differ 2016; 7: 23. https://doi.org/10.1186/s13293-016-0076-8
Rokohl AC, Kopecky A, Trester M, Wawer Matos PA, Pine KR, Heindl LM. Post-enucleation socket syndrome-a novel pathophysiological definition. Graefes Arch Clin Exp Ophthalmol. 2022 Aug;260(8):2427-2431. https://doi.org/10.1007/s00417-022-05648-z
Jaquiéry C, Aeppli C, Cornelius P, Palmowsky A, Kunz C, Hammer B. Reconstruction of orbital wall defects: critical review of 72 patients. Int J Oral Maxillofac Surg. 2007 Mar;36(3):193-9.https://doi.org/10.1016/j.ijom.2006.11.002
Reed D, Papp A, Brundridge W, Mehta A, Santamaria J, Valentin F, Davies B. Evisceration Versus Enucleation Following Ocular Trauma, a Retrospective Analysis at a Level One Trauma Center. Mil Med. 2020 Mar 2;185(3-4):409-412. https://doi.org/10.1093/milmed/usz278
Vaca EE, Mundinger GS, Kelamis JA, Dorafshar AH, Christy MR, Manson PN, et al. Facial fractures with concomitant open globe injury: mechanisms and fracture patterns associated with blindness. Plast Reconstr Surg. 2013 Jun;131(6):1317-1328. https://doi.org/10.1097/PRS.0b013e31828bd4c2
Jabaley ME, Lerman M, Sanders HJ. Ocular injuries in orbital fractures. A review of 119 cases. Plast Reconstr Surg. 1975 Oct;56(4):410-8.https://doi.org/10.1097/00006534-197510000-00007
Rubin PA, Shore JW, Yaremchuk MJ. Complex orbital fracture repair using rigid fixation of the internal orbital skeleton. Ophthalmology. 1992 Apr;99(4):553-9.https://doi.org/10.1016/S0161-6420(92)31933-5
Elbeyli A, Kurtul BE. A Series of Civilian Ocular Injuries from the Civil War in Syria. Beyoglu Eye J. 2020 Dec 28;5(3):205-208. https://doi.org/10.14744/bej.2020.58661
de Moraes ATL, Quaresma MCA, Silva TF, Sousa NWA, Menezes SAF, Ribeiro ALR, et al. Traumatic enucleation of the left globe after a road traffic accident - A case report of an uncommon occurrence in maxillofacial trauma. Int J Surg Case Rep. 2021 Jan;78:133-139. https://doi.org/10.1016/j.ijscr.2020.12.011
Zhou HH, Liu Q, Yang RT, Li Z, Li ZB. Ocular trauma in patients with maxillofacial fractures. J Craniofac Surg. 2014 Mar;25(2):519-23. https://doi.org/10.1097/SCS.0000000000000683
Barak A, Elhalel A, Pikkel J, Krauss E, Miller B. Incidence and severity of ocular and adnexal injuries during the Second Lebanon War among Israeli soldiers and civilians. Graefes Arch Clin Exp Ophthalmol. 2011 Dec;249(12):1771-4.https://doi.org/10.1007/s00417-011-1659-z
Petersen K, Hayes DK, Blice JP, Hale RG. Prevention and management of infections associated with combat-related head and neck injuries. J Trauma. 2008 Mar;64(3 Suppl):S265-76.https://doi.org/10.1097/TA.0b013e318163d2a6
Tsur N, Kotovich D, Dudkiewicz D, Talmy T, Radomislensky I, Givon A; Israel Trauma Group; Benov A, Arbel Y, Rittblat M, Shapira S. Epidemiology of Maxillofacial Injuries in the Swords of Iron War: Insights From a National Registry. Dent Traumatol. 2026 Feb;42(1):71-78. https://doi.org/10.1111/edt.13081
Scott RA, Blanch RJ, Morgan-Warren PJ. Aspects of ocular war injuries. Trauma. 2014;17(2):83-92. https://doi.org/10.1177/1460408614539621
Chepurnyi Yu, Kopchak A, Chernohorskiy D, Petrenko O. Ретроспективний аналіз результатів реконструктивно-відновних втручань при дефектах стінок орбіти методами комп'ютерного моделювання. Archive of Ukrainian Ophthalmology. 2021; 6. 65-70. https://doi.org/10.22141/2309-8147.6.2.2018.172244
Abu-Sitta GS, Ma'luf R, Dabbous H, Hakim C, Chalhoub R. Delayed Periorbital Reconstruction After War Injuries. J Craniofac Surg. 2020 Jul-Aug;31(5):1202-1207.https://doi.org/10.1097/SCS.0000000000006410
Joachim MV, Farsio F, Markiewicz MR, Miloro M. Patient-specific Implants in Post-traumatic Orbital Reconstruction: A Systematic Review. J Oral Maxillofac Surg. 2025 Oct 15:S0278-2391(25)00847-X. https://doi.org/10.1016/j.joms.2025.10.003
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