The Use of a Transparent Corneal Protector Permits Early Detection of Mydriasis to Prevent Blindness during Orbital Wall Fracture Surgery

791 pression of the optic nerve has also been recommend­ ed, but it should be performed within 24 hours and its effectiveness is not clear [3]. Papillary mydriasis occurring during the treatment of blow out fracture might indicate irreversible blindness, because it means that the ciliary ganglion or short ciliary nerves are injured [4]. The ciliary ganglion is located posterolateral to the globe, between the optic nerve and lateral rectus muscle, 1 cm anterior to the superior orbital fissure, and 2.9 mm removed from the optic nerve [5]. Near the optic nerve, the ciliary nerves run inferomedially toward the sphincter papillae muscle and with the ciliary artery above and the optic nerve beneath (Fig. 1). The short ciliary nerves and ciliary ganglion are close to the optic nerve, and mydriasis means the possibility of optic nerve damage. Available corneal protectors are made of opaque material (Fig. 2), and therefore cannot be used to identify immediate changes in pupil size, and thus, surgeons should remove the protector and then reapply it to check the pupil size, which is time­consuming and could cause corneal laceration or abrasion. As a result, we have used the Corneal Shields (AkritiOculoplasty Logistics, Andhra Pradesh, India) transparent corneal protector (Fig. 3). We have used the Corneal Shields protector in patients with a blow out fracture since February of 2013. Before making an incision, the size and symmetry of the pupils in the two eyes is checked, and the protector is applied immediately. When a small increase in pupil size is found during dissection, the dissection is discontinued, because of possible optic nerve injury and intravenous corticosteroid (1,000 mg, dexamethasone) is immediately administered. The herniated soft tissue is then carefully reduced and implant materials are properly inserted. Postoperative The Use of a Transparent Corneal Protector Permits Early Detection of Mydriasis to Prevent Blindness during Orbital Wall Fracture Surgery