Timing of surgery in traumatic globe dislocation

Abstract

Traumatic globe dislocation into the maxillary sinus is a rare event and usually associated with a poor visual outcome if not managed appropriately. We report a 45-year-old female patient who presented to the emergency after blunt injury to her face with a door. Initial evaluation revealed nil perception of light and an apparently anophthalmic socket. Neuroimaging revealed large floor and medial wall fracture with dislocation of the globe into the maxillary sinus. The patient underwent exploration with repositioning of the globe and fracture repair. She was also administered 1 g intravenous methylprednisolone along with tapering course of oral steroids for 3 days. Patient's final visual acuity at 18 months of follow-up improved to counting fingers at 1 m. A thorough review of the literature suggests immediate surgery might improve the final visual outcome in such cases.

Delayed treatment of traumatic eyeball dislocation into the maxillary sinus and treatment algorithm: a case report and literature review

“…To date, only five out of 23 patients have been reported to have received delayed surgical treatment [ 4 , 8 - 11 ]. Four of these patients presented late to the hospital, while one patient’s surgery was postponed due to abnormal neurological findings [ 11 ]. Our patient was unable to undergo emergency surgery because of SAH and hemopneumothorax accompanied by a flail chest.…”

“…To date, only five out of 23 patients have been reported to have received delayed surgical treatment [4,[8][9][10][11]. Four of these patients presented late to the hospital, while one patient's surgery was postponed due to abnormal neurological findings [11].…”

“…We conducted a review of the relevant literature using the keywords "orbital fracture, " "globe dislocation, " "eyeball displacement, " and "maxillary sinus" in the PubMed, Ovid, and Google Scholar databases. We identified a total of 22 papers related to these keywords [3,4,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. These reports included 23 patients (Table 1).…”

“…Of the 23 patients, 21 underwent assessments of postoperative visual acuity. Eleven patients experienced varying degrees of vision recovery, which ranged from light perception or the ability to count fingers to acceptable visual acuity [4,11,19,[21][22][23][24]26]. Nineteen patients received orbital reconstructions.…”