Complete Globe Avulsion in a 13-Year-Old Young Boy with Maxillofacial Injury: A Case Report and Review of Literature

Abstract

Disability is defined as a physical or mental condition that limits a person's movements, senses, or activities. Disability can be congenital or acquired. Modern medicine can only help such an individual with a better lifestyle, but can never cure the condition as a whole. As a result, one is forced to live with it through one's lifetime. Blindness/loss of vision is one such condition which is not only taxing physically but also psychologically especially in a young child. The authors present one such case of complete globe avulsion in maxillofacial trauma due to road traffic accident in a 13-year-old young boy. This case report discusses in detail about the etiology, biomechanics associated with orbital fractures, anophthalmic surgeries, and the various implantation options. The authors would also like to stress the importance of decision making regarding preservation of the globe or enucleation in an emergency situation such as this one, where the patient reports with a “popped out” eyeball. An ophthalmologist along with an oral and maxillofacial surgeon plays a significant role in primary management, restoration, and replacement influencing the final treatment outcome.

Improving the Care Outcomes of Traumatic Enucleation with Artificial Eye Implant: a case report

“…Ocular aches and headaches are other typical symptoms that can occur(7) (9). In traumatic enucleation the mechanism of optic nerve avulsion is not completely understood however several theories have been postulated, such as direct trauma to the globe, shearing forces resulting from extreme rotation of the globe, a sudden massive increase in intraocular pressure resulting in rupture of lamina cribrosa and expulsion of the globe, sudden forward displacement of the globe, and focal or diffuse vasospasm in the optic nerve (10) (11). Since this injury occurred in a Motor Tra c accident in our index case, it is likely to involve combinations of mechanisms.…”

“…The severity of the injury and the patient's general condition are factors that affect the prognosis for patients with traumatic enucleation. However, with adequate management, patients who have enucleation can often anticipate a favorable functional and cosmetic outcome (10). Patients may also develop psychological conditions such as depression, stigma, anxiety, social isolation, and posttraumatic stress disorder and if these are not resolved in good time it can lead to suicidal ideation and eventual suicide (12).…”

“…The use of these implants can improve the quality of life for patients by increasing their self-esteem and satisfaction with their appearance (12) (13). Orbital Infection, hemorrhage, and scarring are possible complications of enucleation (10) however the use of these implants will minimize their effects.…”

Traumatic Globe Luxation: When to Save It?

“…[8] However, if it is impossible to save the eyeball due to severe damage, such as rupture of the entire extraocular muscle accompanied by avulsion of the optic nerve, enucleation can be considered. [14], [15] Sympathetic ophthalmia (SO) is a diffuse bilateral granulomatous uveitis, non-necrotizing panuveitis, which can occur after trauma or surgery involving the uveal tissue in one eye. The eye that is traumatized is called the exciting eye, while the fellow eye is called the sympathizing eye.…”