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A case of postsurgical ocular complications, i. e. bilateral visual impairment after the open reduction of facial fractures is herein reported. The patient was a thirty five year old male, who in an automobile accident was struck on the left facial area by the steering wheel on December 24, 1981. He was temporarily unconscious and bleeding from the mouth and nose. The left pupil was dilated and didn't react to direct or indirect light, thereby peripheral paralysis of the left oculomotorius was suspected. He was noted to have a remarkable malocclusion and was sent to the department of oral surgery. When transfered to our hospital on December 28, 1981, the patient had swelling in the left facial area, a slight depression in the left malar portion and a left pen-orbital purpura. Despite marked subconjunctival hemorrhage no limitation of ocular movements and no diplopia were observed. Visual acuity on the right was 1.5 (n. c.) and on the left 0.6 (n. c.). Upon funduscopy a slight degenerative change of the macula of the left eye was noted. Radiographically, mandibular, Le Fort 3 type, sagittal, and right clavicular fractures were revealed. Open reduction surgery was performed under general anesthesia on January 6, 1982. Immediately after the operation the patient complained of severe headache and abdominal pain. Diplopia and lagophthalmus in the left eye appeared on the fourth postoperative day. Ocular examination revealed a bilateral reduction in visual acuity to 0.2 (n. c.), moderate midriasis in the left eye and decreased intraocular tension in each eye were also evident. Funduscopic examination showed a mild edema in the macular area of both eyes. Fluorescent fundus angiography disclosed moderate leakage and serous retinal detachment, consequently the diagnosis of Harada's disease was made. Steroid hormone and a high osmotic agent were promptly administered. Visual acuity was restored to 1.0 and 0.7 respectively after 40 days of chemotherapy and diplopia disappeared. The intermaxillary fixation was removed on February 18. Although very slight lagophthalmus remained in the left eye, the patient was discharged on the 59 th hospital day. Discussions about postsurgical ocular complications in the case of facial fractures followed. Because the eye is often covered with an eyepatch and swelling after trauma or surgery, early fi ndings of vision loss are easily overlooked, therefore surgeons should pay special attention to finding visual impairment.
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