title: Ocular injury, visual impairment, and blindness associated with facial fractures:  a systematic literature review.
abstract: BACKGROUND
  Injuries to the face can potentially lead to destruction of vital structures, with devastating sequelae to the patient. Facial fractures, especially of the midface, are often complicated by ocular injuries. The purpose of this study was to systematically review the literature to better understand specific fracture patterns associated with ocular injuries, including visual impairment and blindness.
  
  
  METHODS
  The PubMed, EMBASE, and Cochrane databases from January of 2004 to April of 2010 were systematically reviewed to identify relevant studies. Only those that investigated facial fractures with concomitant ocular injuries, visual impairment, and/or blindness were included. Studies that described nonfacial fractures or those that only focused on the function of extraocular muscles were excluded. Case reports, nonsystematic reviews, and studies with fewer than 10 patients were also excluded.
  
  
  RESULTS
  Eleven articles met study criteria and were included for analysis. There were a total of 14,535 patients, with an average of 1211 patients (range, 39 to 4426) per study. Level of evidence included levels II (n = 1 study), III (n = 1), and IV (n = 9). The mean reported rate of acute visual loss was 1.7 percent. Periorbital and orbital blowout fractures were more often complicated by ocular injuries compared with other facial fracture patterns. High-impact zygomatic fractures were most commonly associated with blindness.
  
  
  CONCLUSIONS
  Existing studies exploring ocular injuries, visual impairment, and blindness associated with facial fractures offer conflicting data. Specifically directed studies are required so that significant correlations between specific fracture patterns and specific ocular injuries can be drawn.
  
  
  METHODS
  Risk, IV.
authors.affiliation: Baltimore, Md. From the Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center.
authors.forename: Michael
authors.initials: M
authors.lastname: Magarakis
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Kelamis
authors.forename: Amir H
authors.initials: AH
authors.lastname: Dorafshar
authors.forename: Branko
authors.initials: B
authors.lastname: Bojovic
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D001766:Blindness / Q000209:etiology; D005131:Eye Injuries / Q000209:etiology*; D005147:Facial Bones / Q000293:injuries*; D006801:Humans; D009917:Orbital Fractures / Q000150:complications; D012887:Skull Fractures / Q000150:complications*; D014754:Violence / Q000706:statistics & numerical data; D014786:Vision Disorders / Q000209:etiology*; D015050:Zygoma / Q000293:injuries