Globe luxation reduction
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 rule out orbital deformity, retrobulbar hemorrhage, etc
- Place patient 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 → follow up 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.