A Potential Devastating Complication! IATROGENIC OCULAR TRAUMA I atrogenic trauma to ocular structures may occur during extraction of the maxillary fourth premolar, first molar, or second molar teeth. The cause of such trauma is related to the thin alveolar bone and proximity of the ventral floor of the orbit combined with technique that is too forceful. Another contributing factor may be that the clinician is unaware of the degree of periodontal pathology that may be present in the area decreasing the bony integrity of the ventral floor of the orbit (Fig. 1). Ocular structures adjacent to the caudal maxillary teeth may be perforated by a pointed instrument such as a periodontal elevator, especially in patients with destructive periodontal disease (Fig. 2). Panophthalmitis may result from perforation of the globe by the periodontal elevator. If antimicrobial and anti-inflammatory treatment fails, enucleation is an unfortunate result. Other complications from iatrogenic orbital trauma include periocular skin necrosis and brain abscessation (Figs. 3 and 4). This complication is preventable by using controlled force and a palm grip on the periodontal elevator with fingers placed near the working end or tip of the instrument. This grip limits accidental penetration of the instrument to the distance between fingers and the tip of the instrument (Fig. 5). Also, angling the periodontal elevator perpendicular to the tooth roots, instead of parallel, avoids accidental orbital penetration. Preoperative dental radiographs allow the clinician to assess the degree of periodontal bone loss. Although careful technique is always warranted during tooth extraction, evidence of periodontal pathology alerts the clinician to be especially diligent in adherence to proper extraction techniques. 1 2 3 . . . California Veterinarian | May/June 2011 46 by Mark M. Smith, VMD, DACVS, DAVDC