Globe luxation reduction: Difference between revisions
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==Background== | ==Background== | ||
*Extreme proptosis which permits lids to slip behind globe equator, obicularis oculi spasm sustains luxation | *Extreme proptosis which permits lids to slip behind globe equator, obicularis oculi spasm sustains luxation | ||
*Can be traumatic or | *Can be traumatic, spontaneous or voluntary | ||
**In spontaneous globe luxation, extraocular muscles and optic nerve generally remain intact.<ref>Tok L, Tok OY, Argun TC, et al. Bilateral Traumatic Globe Luxation with Optic Nerve Transection. Case Reports in Ophthalmology. 2014;5(3):429-434. doi:10.1159/000370043.</ref> | **In spontaneous globe luxation, extraocular muscles and optic nerve generally remain intact.<ref>Tok L, Tok OY, Argun TC, et al. Bilateral Traumatic Globe Luxation with Optic Nerve Transection. Case Reports in Ophthalmology. 2014;5(3):429-434. doi:10.1159/000370043.</ref> | ||
**In traumatic globe luxation, optic nerve avulsion is common (occurs in 38.2%)<ref>Amaral MB, 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. 2015 Mar;14(Suppl 1):323-30.</ref> | **In traumatic globe luxation, optic nerve avulsion is common (occurs in 38.2%)<ref>Amaral MB, 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. 2015 Mar;14(Suppl 1):323-30.</ref> | ||
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==Follow-Up== | ==Follow-Up== | ||
*Traumatic luxation requires emergent ophthalmology consult | *Traumatic luxation requires emergent ophthalmology consult | ||
*Spontaneous luxation with no visual impairment → f/u in 24-48 hours, avoid triggering maneuvers | *Spontaneous luxation (s/p reduction) with no visual impairment → f/u in 24-48 hours, avoid triggering maneuvers | ||
==References== | ==References== | ||
Revision as of 01:06, 27 June 2015
Background
- Extreme proptosis which permits lids to slip behind globe equator, obicularis oculi spasm sustains luxation
- Can be traumatic, spontaneous or voluntary
- Early reduction indicated to relieve symptoms and minimize visual impairment
Indications
- Spontaneous or traumatic globe luxation
Contraindications
- Globe rupture (relative)
Procedure
- Perform rapid eye exam including visual acuity
- If traumatic, consider imaging to r/o orbital deformity, retrobulbar hemorrhage, etc
- Place pt in recumbent position
- Apply topical ocular anesthetic (e.g. tetracaine)
- When lashes are visible, have asst apply steady upward and outward traction to lids. If unable to grasp lashes, use lid retractor to apply countertraction
- With gloved fingers, gently apply scleral pressure and manipulate back into orbit
- Assess for and remove retained lashes to prevent corneal injury
- Repeat eye exam (acuity may not improve for days or longer)
Complications
- Retained lashes
- Failure to reduce (apply saline drops and non-contact eye shield)
Follow-Up
- Traumatic luxation requires emergent ophthalmology consult
- Spontaneous luxation (s/p reduction) with no visual impairment → f/u in 24-48 hours, avoid triggering maneuvers
References
- ↑ Tok L, Tok OY, Argun TC, et al. Bilateral Traumatic Globe Luxation with Optic Nerve Transection. Case Reports in Ophthalmology. 2014;5(3):429-434. doi:10.1159/000370043.
- ↑ Amaral MB, 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. 2015 Mar;14(Suppl 1):323-30.