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Kim AH, Kim J, Nayer ZH, Plum W, Glass LRD. Management of traumatic globe subluxation with optic nerve and extraocular muscle transection. Orbit 2023:1-6. [PMID: 38009285 DOI: 10.1080/01676830.2023.2283185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/07/2023] [Indexed: 11/28/2023]
Abstract
A care algorithm for partial globe subluxation cases with optic nerve and at least one extraocular muscle (EOM) transection is presented after a literature review was performed using key term variations of globe, ocular, subluxation, optic nerve evulsion or transection, and trauma. Partial globe subluxation cases with transection of the optic nerve and at least 1 EOM were included. Exclusion criteria included globe rupture, complete enucleation defined by a globe without at least 1 EOM attachment, or unclear details confirming optic nerve transection. Including the patient presented herein, a total of 24 patients with 26 eyes were analyzed. About 73.08% of cases underwent initial repositioning (n = 19), with 11.54% of those requiring secondary enucleation or evisceration (n = 3). Of the secondarily managed cases, 2 of the 3 cases listed pain (n = 2) and inadequate cosmesis (n = 1) as rationale. We found that 26.92% of cases underwent initial enucleation (n = 7), citing lack of visual potential and limiting later complications. Most cases favored repositioning, which was typically sustainable. Initial repositioning can improve cosmetic outcome and psychological impact. Given the low risk of later management, cases of traumatic partial subluxation with EOM and optic nerve transections should attempt initial repositioning.
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Affiliation(s)
- Angela H Kim
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
- College of Medicine, The State University of New York at Downstate Medical Center, Brooklyn, New York, USA
| | - Janice Kim
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Zacharia H Nayer
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - William Plum
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Lora R Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
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Agrawal S, Das D, Modaboyina S, Singh P, Samdani A, Pushker N. Contralateral field defect in traumatic globe luxation with optic nerve injury. Clin Exp Optom 2021; 105:410-413. [PMID: 34320329 DOI: 10.1080/08164622.2021.1932432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Clinical relevance: Traumatic globe luxation is rare vision-threatening event. Besides causing loss of vision in traumatised eye, it may also cause injury to contralateral optic nerve. Any such limitation in a one-eyed patient can make him crippled in his day-to-day activities. Here we hypothesise cause of contralateral field defect in such patients.Background: Traumatic globe luxation is a rare event that leads to profound vision loss due to injury of the ipsilateral optic nerve and rarely a visual field defect in the contralateral eye. Through this communication, we report similar case scenarios and intend to hypothesize the mechanism that results in the occurrence of the contralateral visual field defect.Methods: It is a retrospective, observational study. All cases with traumatic globe luxation were enrolled. Visual field analysis of the contralateral normal eye was main outcome measure.Results: Four patients with traumatic globe luxation and optic nerve injury were studied. There was complete loss of vision in the traumatised eye in all the patients. One patient had complete transection of the optic nerve, whereas in three patients, the course of the optic nerve was intact, on imaging. Three patients had quadrantanopia in the contralateral normal eye for which oral steroids were given. At 1-month follow-up, there was complete recovery of the visual field defect in two patients. We noticed that all the three patients with an intact course of the ipsilateral optic nerve had quadrantanopia in the contralateral normal eye.Conclusion: We hypothesize that in scenarios where globe luxation is associated with incomplete transection or no transection of the optic nerve, a continuous long standing stretch on the optic nerve, transmits the pulling force to the chiasma which might result in a contralateral field defect as compared to those associated with the complete transection of the optic nerve.
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Affiliation(s)
- Sahil Agrawal
- Oculoplasty & Paediatric Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepsekhar Das
- Oculoplasty & Paediatric Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sujeeth Modaboyina
- Oculoplasty & Paediatric Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pallavi Singh
- Oculoplasty & Paediatric Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Asha Samdani
- Oculoplasty & Paediatric Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Oculoplasty & Paediatric Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Prior A, Allegretti L, Melloni I, Bovio M, Laganà F, Ceraudo M, Zona G. Traumatic subarachnoid hemorrhage related to ophthalmic artery avulsion: a case report. Acta Neurochir (Wien) 2018; 160:913-917. [PMID: 29445965 DOI: 10.1007/s00701-018-3486-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/06/2018] [Indexed: 12/19/2022]
Abstract
We present a case of ophthalmic artery (OA) traumatic avulsion, leading to a post-traumatic subarachnoid hemorrhage (SAH) with ventricular blood invasion and hydrocephalus, mimicking an internal carotid aneurysm rupture. This is the third case of such an event reported in literature and the first without orbital fractures and optic nerve avulsion. Conservative treatment was sufficient for the avulsion, but surgery was needed for the coexisting eye luxation. Traumatic OA avulsion is a rare but possible event and should be suspected in case of basal cisterns SAH, evidence of orbital trauma and CT angiogram or angiographic absence of opacification of the OA.
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Affiliation(s)
- Alessandro Prior
- Clinica Neurochirurgica e Neurotraumatologica, IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Luca Allegretti
- U.O. Neuroradiologia, IRCCS Policlinico San Martino, Genoa, Italy
| | - Ilaria Melloni
- Clinica Neurochirurgica e Neurotraumatologica, IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
| | - Marta Bovio
- U.O. Medicina e Chirurgia d'Accettazione e Urgenza, IRCCS Policlinico San Martino, Genoa, Italy
| | - Francesco Laganà
- U.O. Chirurgia Maxillo-faciale, IRCCS Policlinico San Martino, Genoa, Italy
| | - Marco Ceraudo
- Clinica Neurochirurgica e Neurotraumatologica, IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Gianluigi Zona
- Clinica Neurochirurgica e Neurotraumatologica, IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
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Noman SA, Shindy MI. Immediate Surgical Management of Traumatic Dislocation of the Eye Globe into the Maxillary Sinus: Report of a Rare Case and Literature Review. Craniomaxillofac Trauma Reconstr 2016; 10:151-158. [PMID: 28523089 DOI: 10.1055/s-0036-1584393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/28/2016] [Indexed: 01/16/2023] Open
Abstract
We report a case of complete dislocation of the globe into the maxillary sinus, with immediate repositioning of the globe. This report highlights the importance of early surgical repair of orbital fracture and globe repositioning to regain the maximum amount of ocular functions. A review of literature found 19 cases of globe dislocation into the maxillary sinus: One case was enucleated 2 months after misdiagnosis as traumatic enucleation, six cases were documented no vision or no light perception, three cases did not have reported vision (patients did not survive), and nine cases with postoperative vision. We recommend early surgical intervention to restore the cosmetic and visual function of the dislocated eye.
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Affiliation(s)
- Samer Abduljabar Noman
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Sana'a University, Sana'a, Yemen
| | - Mostafa Ibrahim Shindy
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
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Tok L, Tok OY, Argun TC, Yilmaz O, Gunes A, Unlu EN, Sezer S, Ibisoglu S, Argun M. Bilateral traumatic globe luxation with optic nerve transection. Case Rep Ophthalmol 2015; 5:429-34. [PMID: 25606034 PMCID: PMC4296245 DOI: 10.1159/000370043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The purpose of this study was to document clinical findings and management of a patient with bilateral globe luxation and optic nerve transection. MATERIALS AND METHODS A 25-year-old female patient was admitted to the emergency department with bilateral traumatic globe luxation following a motor vehicle accident. RESULTS Visual acuity testing showed no light perception. The right pupil was dilated and bilaterally did not react to light. The globes were bilaterally intact. A computed tomography scan revealed Le Fort type II fractures, bilateral optic nerve transection and disruption of all extraocular muscles. The globes of the patient were bilaterally reduced into the orbit. However, the patient developed phthisis bulbi in the right eye at month 3. CONCLUSION Globe luxation presents a dramatic clinical picture, and may lead to the development of severe complications due to the concomitance of complete optic nerve dissection and multiple traumas. Even if the luxated globe is repositioned into the orbit, there is still an increased risk of the development of phthisis due to ischemia.
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Affiliation(s)
- Levent Tok
- Department of Ophthalmology, Faculty of Medicine, Süleyman Demirel University, Isparta, Burdur, Turkey
| | - Ozlem Yalcin Tok
- Department of Ophthalmology, Faculty of Medicine, Süleyman Demirel University, Isparta, Burdur, Turkey
| | - Tugba Cakmak Argun
- Department of Ophthalmology, Faculty of Medicine, Süleyman Demirel University, Isparta, Burdur, Turkey
| | - Omer Yilmaz
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, Isparta, Burdur, Turkey
| | - Alime Gunes
- Department of Ophthalmology, Faculty of Medicine, Süleyman Demirel University, Isparta, Burdur, Turkey
| | - Elif Nisa Unlu
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, Isparta, Burdur, Turkey
| | - Sezgin Sezer
- Department of Ophthalmology, Burdur State Hospital, Burdur, Turkey
| | - Seda Ibisoglu
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, Isparta, Burdur, Turkey
| | - Mehmet Argun
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, Isparta, Burdur, Turkey
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Amaral MBF, Carvalho MF, Ferreira AB, Mesquita RA. Traumatic globe luxation associated with orbital fracture in a child: a case report and literature review. J Maxillofac Oral Surg 2013; 14:323-30. [PMID: 25861192 DOI: 10.1007/s12663-013-0539-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/16/2013] [Indexed: 12/27/2022] Open
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.
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Affiliation(s)
- Márcio Bruno Figueiredo Amaral
- Oral and Maxillofacial Surgery Service, Hospital João XXIII/FHEMIG, Av. Professor Alfredo Balena, 400, Santa Efigênia, Belo Horizonte, MG 30130-100 Brazil ; Department of Oral and Maxillofacial Surgery, School of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Av. Dom José Gaspar, 500, Coração Eucarístico, Belo Horizonte, MG 30535-901 Brazil ; Department of Oral Surgery and Pathology. School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG 31270-901 Brazil
| | - Matheus Furtado Carvalho
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Av. Dom José Gaspar, 500, Coração Eucarístico, Belo Horizonte, MG 30535-901 Brazil
| | - André Baptista Ferreira
- Ophthalmologic Service, Hospital João XXIII/FHEMIG, Av. Alfredo Balena, 400, Santa Efigênia, Belo Horizonte, MG 30130-100 Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology. School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG 31270-901 Brazil
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Yaman A, Ozturk T, Soylev MF. Reversal of optic neuropathy secondary to voluntary globe luxation. J AAPOS 2009; 13:210-2. [PMID: 19157936 DOI: 10.1016/j.jaapos.2008.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 09/07/2008] [Accepted: 09/25/2008] [Indexed: 10/21/2022]
Abstract
Luxation of the globe is rare in the general population and may be spontaneous, voluntary, or traumatic. Spontaneous or voluntary globe luxation results from shallow orbit, floppy eyelids, lax orbital ligaments, backward displacement of orbital septum, or proptotic eyes due to orbital tumors or infiltrative processes, as in Grave's ophthalmopathy. The authors report a case with unilateral voluntary globe luxation presented with unilateral progressive visual loss.
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Affiliation(s)
- Aylin Yaman
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey.
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Abstract
Optic nerve head avulsion is a rare condition. It consists in a rupture of the nerve fibers at the level of the lamina cribrosa followed by a retraction of these fibers into the intact optic sheath. We report a case of optic nerve head avulsion following globe contusion. The association of a sudden forced globe rotation, a possible acute proptosis, and a sudden rise in intraocular pressure likely caused the avulsion. The presence of intraocular hemorrhages did not prevent examination of the optic nerve head region, which showed a crater. Initial visual acuity was no light perception. An orbit bone fracture was ruled out after CT examination. The patient was treated with general antibiotics and eyedrops (antibiotic/corticosteroid and atropine). No visual recovery was observed.
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Affiliation(s)
- E Denion
- Centre hospitalier Andrée Rosemon, Cayenne.
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Lelli GJ, Demirci H, Frueh BR. Avulsion of the optic nerve with luxation of the eye after motor vehicle accident. Ophthalmic Plast Reconstr Surg 2007; 23:158-60. [PMID: 17413639 DOI: 10.1097/iop.0b013e31803045b4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 27-year-old man suffered simultaneous avulsion of the optic nerve and luxation of an intact globe in a motor vehicle accident. CT was not diagnostic of the nerve avulsion. The injury was addressed by emergent replacement of the globe within the orbit. The patient obtained psychological benefit by retaining the eye initially, but required subsequent enucleation for prolonged ocular inflammation. Initial repositioning of intact, luxated globes offers potential cosmetic and psychological benefits. If necessary, enucleation can be performed later.
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Affiliation(s)
- Gary J Lelli
- Department of Ophthalmology and Visual Sciences, University of Michigan, W.K. Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI 48105, USA
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