Post-traumatic lagophthalmos complicated by ocular evisceration Case report
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Published:
May 27, 2025
Keywords:
evisceration, post-traumatic lagophthalmos, corneal malaise
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Abstract
Introduction: Post-traumatic lagophthalmos is a significant clinical challenge, leading to serious ocular health consequences. This article examines the diagnostic, therapeutic aspects and outcomes of this important pathology.
Material and methods: A 78-year-old patient with lagophthalmos of the left eye after a traffic accident with loss of consciousness was referred to our clinic.
Results: Post-traumatic lagophthalmos is a complex clinical challenge. Craniofacial and eyelid reconstruction, despite a complex course, failed to fully restore function and aesthetics. Due to corneal complications and ocular inflammation, a left ocular evisceration with eyelid reconstruction using ear cartilage and a skin flap was performed.
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1.
Górska A, Sirek S, Pojda-Wilczek D. Post-traumatic lagophthalmos complicated by ocular evisceration. Ophthatherapy [Internet]. 2025May27 [cited 2025Jun.30];00. Available from: https://journalsmededu.pl/index.php/ophthatherapy/article/view/3110
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Surgery and laser therapy
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Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
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28. Aveta A, Casati P. Soft tissue injuries of the face: early aesthetic reconstruction in polytrauma patients. Ann Ital Chir. 2008; 79: 415-7.
29. Ko AC, Satterfield KR, Korn BS et al. Eyelid and Periorbital Soft Tissue Trauma. Facial Plast Surg Clin North Am. 2017; 25(4): 605-16.
30. Fischer T, Noever G, Langer M et al. Experience in upper eyelid reconstruction with the Cutler-Beard technique. Ann Plast Surg. 2001; 47(3): 338-42.
31. Hughes WL. A new method for rebuilding a lower lid: report of a case. Arch Ophthalmol. 1937; 17: 1008-17.
32. Suresh P, Mercieca F, Morton A et al. Eye care for the critically ill. Int Care Med. 2000; 26: 162-6.
33. Dawson D. Development of a new eye care guideline forcritically ill patients. Int Crit Care Nurs. 2005; 21: 119-22.
34. Ezra DG, Chan MP, Solebo L et al. Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill. Int Care Med. 2009; 35: 455-61.
35. Koroloff N, Boots R, Lipman J et al. A randomised controlled study of the efficacy of hypromellose and Lacri-Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient. Int Care Med. 2004; 30: 1122-6.
36. So HM, Lee CC, Leung AK et al. Comparing the effectiveness of polyethylene covers (Gladwrap) with lanolin (Duratears) eye ointment to prevent corneal abrasions in critically ill patients: a randomized controlled study. Int J Nurs Stud. 2008; 45: 1565-71.
37. Cortese D, Capp L, McKiley S. Moisture chamber versus lubrication for the prevention of corneal epithelial breakdown. Am J Crit Care. 1995; 4: 425-8.
38. Douglas L, Berry S. Developing clinical guidelines in eye care for intensive care units. Nurs Child Young People. 2011; 23: 14-20.
39. Dua HS. Bacterial keratitis in the critically ill and comatose patient. Lancet. 1998; 351: 387-8.
40. Rosenberg JB, Eisen LA. Eye care in the intensive care unit: Narrative review and meta-analysis. Crit Care Med. 2008; 36: 3151-5.
41. Grixti A, Sadri M, Edgar J et al. Common ocular surface disorders in patients in intensive care units. Ocul Surf. 2012; 10(1): 26-42.
42. Parkin B, Turner A, Moore E et al. Bacterial keratitis in the critically ill. Br J Ophthalmol. 1997; 81: 1060-3.
43. Marshall AP, Elliott R, Rolls K et al. Eyecare in the critically ill: Clinical practice guideline. Aust Crit Care. 2008; 21: 97-109.
44. Kirwan JF, Potamitis T, El-Kasaby H et al. Microbial keratitis in intensive care. BMJ. 1997; 314: 433-4.
45. Hilton E, Adams AA, Uliss A et al. Nosocomial bacterial eye infections in intensive-care units. Lancet. 1983; 1: 1318-20.
46. Hutton WL, Sexton RR. Atypical Pseudomonas corneal ulcers in semicomatose patients. Am J Ophthalmol. 1972; 73: 37-9.
47. Ommeslag D, Colardyn F, De Laey J. Eye infections caused by respiratory pathogens in mechanically ventilated patients. Crit Care Med. 1987; 15: 80-1.
2. American Academy of Ophthalmology Basic Clinical Science Course: External Disease and Cornea. Vol. 8. Skuta GL, Cantor LB, Cioffi GA et al. (eds.). American Academy of Ophthalmology, San Francisco, CA 2013: 44-50, 58-66.
3. Kanski JJ, Bowling B. Clinical Ophthalmology: A Systemic Approach (Seventh Edition). Elsevier Saunders, New York 2011: 34-9.
4. Schaumberg DA, Nichols JJ, Papas EB et al. The International Workshop on Meibomian Gland Dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci. 2011; 52: 1994-2005.
5. Cook BE Jr., Bartley GB. Epidemiologic characteristics and clinical course of patients with malignant eyelid tumors in an incidence cohort in Olmsted County, Minnesota. Ophthalmology. 1999; 106(4): 746-50.
6. Flach AJ. Eye Injuries. In: Current Diagnosis & Treatment: Occupational & Environmental Medicine, 5e. LaDou J, Harrison RJ. (eds.). McGraw-Hill, New York, NY 2013.
7. Tabatabaei A, Kasaei A, Nikdel M et al. Clinical characteristics and causality of eye lid laceration in Iran. Oman Med J. 2013; 28(2): 97-101.
8. Ing E. Eyelid Laceration Clinical Presentation: History, Physical, Causes. Medscape.
9. Swartz J, Lu K, Camilon M et al. Eyelid laceration. EyeWiki.
10. Pargament JM, Armenia J, Nerad JA. Physical and chemical injuries to eyes and eyelids. Clin Dermatol. 2015; 33: 234-7.
11. Wladis EJ, Dewan MA. Periorbital Trauma from Pit Bull Terrier Attacks. Orbit. 2012; 31(3): 200-2.
12. Soll DB. Treatment of late traumatic eyelid problems. Trans Am Acad Ophthalmol Otolaryngol. 1976; 81: 0P560-565.
13. Carroll RP. Management of eyelid trauma. In: Oculoplastic orbital, and reconstructive surgery. Hornblass A (ed.). Williams & Wilkins, Baltimore 1988: 409-14.
14. Rezaei K, Amini N, Rezaei R et al. The Effects of Passive Blinking on Exposure Keratopathy among Patients in Intensive Care Units. Iran J Nurs Midwifery Res. 2022; 27(2): 144-8.
15. McHugh J, Alexander P, Kalhoro A et al. Screening for ocular surface disease in the intensive care unit. Eye. 2008; 22: 1465‑8.
16. Kuruvilla S, Peter J, David S et al. Incidence and risk factor evaluation of exposure keratopathy in critically ill patients: A cohort study. J Crit Care. 2015; 30: 400‑4.
17. Oliveira RS, Fernandes APN de L, Botarelli FR et al. Risk factors for injury in the cornea in critical patients in intensive care: An integrative review. Revista de Pesquisa: Cuidado é Fundamental Online. 2016; 8: 4423‑34.
18. Kam KR, Haldar S, Papamichael E et al. Eye care in the critically ill: A national survey and protocol. J Intensive Care Soc. 2013; 14: 150‑4.
19. Azfar MF, Khan MF, Alzeer AH. Protocolized eye care prevents corneal complications in ventilated patients in a medical intensive care unit. Saudi J Anaesth. 2013; 7: 33.
20. Kousha O, Kousha Z, Paddle J. Incidence, risk factors and impact of protocolised care on exposure keratopathy in critically ill adults: A two‑phase prospective cohort study. Crit Care. 2018; 22: 1‑8.
21. Kocaçal Güler E, Eşer İ, Eğrilmez S. Nurses can play an active role in the early diagnosis of exposure keratopathy in intensive care patients. Jpn J Nurs Sci. 2018; 15: 31‑8.
22. Davoodabady Z, Rezaei K, Rezaei R. The impact of normal saline on the incidence of exposure keratopathy in patients hospitalized in intensive care units. Iran J Nurs Midwifery Res. 2018; 23: 57.
23. Sharjeel M, Malik IQ. Prevention of exposure keratopathy with sahaf wet chamber. Pak J Ophthalmol. 2015; 31: 131‑6.
24. Mercieca F, Suresh P, Morton A et al. Ocular surface disease in intensive care unit patients. Eye (Lond). 1999; 13: 231-6.
25. Imanaka H, Taenaka N, Nakamura J et al. Ocular surface disorders in the critically ill. Anesth Analg. 1997; 85: 343-6.
26. Jammal H, Khader Y, Shihadeh W et al. Exposure keratopathy in sedated and ventilated patients. J Crit Care. 2012; 27: 537-41.
27. Benzil DL, Robotti E, Dagi TF et al. Early singlestage repair of complex craniofacial trauma. Neurosurgery. 1992; 30: 166-71.
28. Aveta A, Casati P. Soft tissue injuries of the face: early aesthetic reconstruction in polytrauma patients. Ann Ital Chir. 2008; 79: 415-7.
29. Ko AC, Satterfield KR, Korn BS et al. Eyelid and Periorbital Soft Tissue Trauma. Facial Plast Surg Clin North Am. 2017; 25(4): 605-16.
30. Fischer T, Noever G, Langer M et al. Experience in upper eyelid reconstruction with the Cutler-Beard technique. Ann Plast Surg. 2001; 47(3): 338-42.
31. Hughes WL. A new method for rebuilding a lower lid: report of a case. Arch Ophthalmol. 1937; 17: 1008-17.
32. Suresh P, Mercieca F, Morton A et al. Eye care for the critically ill. Int Care Med. 2000; 26: 162-6.
33. Dawson D. Development of a new eye care guideline forcritically ill patients. Int Crit Care Nurs. 2005; 21: 119-22.
34. Ezra DG, Chan MP, Solebo L et al. Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill. Int Care Med. 2009; 35: 455-61.
35. Koroloff N, Boots R, Lipman J et al. A randomised controlled study of the efficacy of hypromellose and Lacri-Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient. Int Care Med. 2004; 30: 1122-6.
36. So HM, Lee CC, Leung AK et al. Comparing the effectiveness of polyethylene covers (Gladwrap) with lanolin (Duratears) eye ointment to prevent corneal abrasions in critically ill patients: a randomized controlled study. Int J Nurs Stud. 2008; 45: 1565-71.
37. Cortese D, Capp L, McKiley S. Moisture chamber versus lubrication for the prevention of corneal epithelial breakdown. Am J Crit Care. 1995; 4: 425-8.
38. Douglas L, Berry S. Developing clinical guidelines in eye care for intensive care units. Nurs Child Young People. 2011; 23: 14-20.
39. Dua HS. Bacterial keratitis in the critically ill and comatose patient. Lancet. 1998; 351: 387-8.
40. Rosenberg JB, Eisen LA. Eye care in the intensive care unit: Narrative review and meta-analysis. Crit Care Med. 2008; 36: 3151-5.
41. Grixti A, Sadri M, Edgar J et al. Common ocular surface disorders in patients in intensive care units. Ocul Surf. 2012; 10(1): 26-42.
42. Parkin B, Turner A, Moore E et al. Bacterial keratitis in the critically ill. Br J Ophthalmol. 1997; 81: 1060-3.
43. Marshall AP, Elliott R, Rolls K et al. Eyecare in the critically ill: Clinical practice guideline. Aust Crit Care. 2008; 21: 97-109.
44. Kirwan JF, Potamitis T, El-Kasaby H et al. Microbial keratitis in intensive care. BMJ. 1997; 314: 433-4.
45. Hilton E, Adams AA, Uliss A et al. Nosocomial bacterial eye infections in intensive-care units. Lancet. 1983; 1: 1318-20.
46. Hutton WL, Sexton RR. Atypical Pseudomonas corneal ulcers in semicomatose patients. Am J Ophthalmol. 1972; 73: 37-9.
47. Ommeslag D, Colardyn F, De Laey J. Eye infections caused by respiratory pathogens in mechanically ventilated patients. Crit Care Med. 1987; 15: 80-1.