Globe luxation reduction

Background

1. Extreme proptosis which permits lids to slip behind globe equator, obicularis oculi spasm sustains luxation
2. Early reduction indicated to relieve symptoms and minimize visual impairment

Indication

1. Globe luxation

Relative Contraindication

1. Globe rupture

Procedure

1. Perform rapid eye exam including acuity
2. If traumatic, consider imaging to r/o orbital deformity, retrobulbar hemorrhage, etc
3. Place pt in recumbent position
4. Apply topical ocular anesthetic
5. 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
6. With gloved fingers, gently apply scleral pressure and manipulate back into orbit
7. Assess for and remove retained lashes to prevent corneal injury
8. Repeat eye exam (acuity may not improve for days or longer)

Complications

1. Retained lashes
2. Failure to reduce (apply saline drops and non-contact eye shield)

After Care

1. Traumatic luxation requires emergent ophthalmology consult
2. Spontaneous luxation with no visual impairment- f/u in 24-48 hrs. avoid triggering maneuvers

Source

Roberts: Clinical Procedures in EM, 5th ed