Traumatic Globe Luxation Associated with Orbital Fracture in a Child: A Case Report and Literature Review

Abstract

Orbital fracture associated with traumatic globe luxation is rare, as it generally requires trauma with high energy for this to occur. The present case report focused on a child who had been hit by a motorcycle, leading to a globe luxation of the left eye and fractures of the superolateral orbital walls. The patient presented initial cosmetic and psychological benefits from the repositioning of the intact globe and the reduction of the orbital fractures. However, a subsequent evisceration of the globe was required due to persistent proptosis and pain. An ocular prosthesis was also implanted, thus recovering the patient's aesthetics. Thirty-four well-documented cases of traumatic globe luxation could be found in the English literature since 1970. The mean age of patients presenting traumatic globe luxation was 29.5 years. The male gender proved to be more prevalent, with traffic collisions representing the most common accident etiology. Direct orbital trauma with fractures of medial and floor walls displacing the globe into the maxillary sinus represented the most common injury mechanism (38.2 %), followed by an elongated object entering the orbit (26.5 %). Optical nerve avulsion is the most serious complication seen in association with traumatic globe luxation, with the repositioning of the initial globe, with no enucleation or evisceration, representing the main form of management.

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

“…These data are in accordance with an epidemiological study in which maxillofacial trauma were evaluated. 5 Luxation of the globe is a rare ocular condition following trauma, where there is a forward displacement of the eyeball so that the eyelids spasmodically close behind it, but the eye muscles and the optic nerve generally remain intact. Avulsion of the globe is where the muscles and the optic nerve are partially or totally severed.…”

“…Other possible mechanisms of injury are narrowing of the posterior orbit by orbital fractures (11.8%), deceleration force, sudden intraorbital rise in pressure, and direct traction of the globe. 5,11 The mechanism of optic nerve avulsion is not completely understood. 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 (Sanborn et al, 1984 andVries Knopper, 1989).…”

A successful case of surgical intervention for traumatic globe luxation in a child: From light perception to full visual acuity

“…This complication has reportedly occurred in 38.2% of the published cases. [3] Moreover, if optic nerve avulsion does not occur, the final VA shows a good prognosis even with a poor vision. In one report, a 25-year-old man presented with his globe luxated out of the orbit and full optic nerve avulsion after a motor vehicle accident.…”

“…[1,2] Because traumatic globe luxation can lead to vision loss in some cases, it is an important condition in emergency rooms. [3] Hence, all physicians, particularly those working at emergency units, should be familiar with this condition and its management to be able to prevent organ-threatening complications, such as vision loss.…”

Immediate Surgical Management of Traumatic Dislocation of the Eye Globe into the Maxillary Sinus: Report of a Rare Case and Literature Review

“…Anterior or forward luxation of the globe 18 cases. 4,5,[7][8][9][10][11][12][13][14][15][16][17][18][19] Globe dislocation into anterior cranial fossa 3 cases. [20][21][22] Globe dislocation into ethmoid sinus 5 cases.…”