title: Blindness following severe midfacial trauma--case report and review.
abstract: OBJECTIVE
  Severe trauma of the viscerocranium or neurocranium may result in impaired visual acuity or even blindness. Case based epidemiology, pathomechanism and actual strategies in midfacial trauma for initial therapy and prevention of posttraumatic blindness are discussed.
  
  
  METHODS
  A 58-year old patient was treated at our Department of Oral and Maxillofacial Plastic Surgery after his central midface had been hit by a swinging steel girder. Initially he was blind on both eyes. Initial treatment started by applying 24 mg of dexamethasone and omeprazole. During the following 2 weeks, amaurosis persisted on the left eye. On the right eye complete visual acuity was regained. On the basis of data from our Department of Oral and Maxillofacial Plastic Surgery an Odds Ratio of 0.12 was calculated for the combination of blindness and midfacial trauma. Today cortisol therapy is still used. However, hypothermia, anti-Trendelenburg position, and application of mannitol seem to be more effective therapeutic strategies. Erythropoetine and progesterone are promising drugs with neuroprotective, anti-inflammatory as well as anti-oedematous effects.
  
  
  CONCLUSIONS
  The risk of blindness is higher than expected. Latest findings regarding the neuroprotective effects of erythropoetine or/and progesterone seem to promise a more successful treatment.
authors.affiliation: Department of Oral and Maxillofacial Plastic Surgery, Rostock University, Rostock, Germany. amidelis@gmx.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Roth
authors.forename: Volker
authors.initials: V
authors.lastname: Hingst
authors.forename: Jan-Hendrik
authors.initials: JH
authors.lastname: Lenz
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001766:Blindness / Q000209:etiology*; D003907:Dexamethasone / Q000627:therapeutic use; D005147:Facial Bones / Q000293:injuries*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D009915:Orbit / Q000293:injuries; D011239:Prednisolone / Q000627:therapeutic use; D019291:Skull Base / Q000293:injuries; D012887:Skull Fractures / Q000150:complications*; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D000893:Anti-Inflammatory Agents; D000897:Anti-Ulcer Agents; D005938:Glucocorticoids; D003907:Dexamethasone; D011239:Prednisolone; D009853:Omeprazole