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Bilateral traumatic globe luxation with optic nerve transection.

Tok L, Tok OY, Argun TC, Yilmaz O, Gunes A, Unlu EN, Sezer S, Ibisoglu S, Argun M - Case Rep Ophthalmol (2014)

Bottom Line: The right pupil was dilated and bilaterally did not react to light.The globes of the patient were bilaterally reduced into the orbit.Even if the luxated globe is repositioned into the orbit, there is still an increased risk of the development of phthisis due to ischemia.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Faculty of Medicine, Süleyman Demirel University, Isparta, Burdur, Turkey.

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.

No MeSH data available.


Related in: MedlinePlus

Anterior segment ischemia and phthisis bulbi in the right eye.
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Figure 3: Anterior segment ischemia and phthisis bulbi in the right eye.

Mentions: Approximately 10 h after hospital admission, the patient underwent reduction of the globe into the orbit under general anesthesia. In the meantime, the globes were preserved and kept wet using artificial tear gel. Rather than a major surgery, it was planned to perform the reduction of the globe into the orbit because of the existence of bilateral transection in the optic nerves of the patient, visual hopelessness, posterior extraocular muscle rupture and the risk of not finding the ruptured muscles. During the operation, the socket was enlarged with lateral canthotomy, and then the globes were gently repositioned into the orbit with the assistance of an orbital plate and Desmarres lid retractor. The patient underwent bilateral temporary tarsorrhaphy, and a compression pad and bandage were applied. The compression closure was removed on day 3 and the tarsorrhaphy sutures on day 10. There was progressive and unresponsive edema in the right cornea. On the subsequent days, an ulcer developed, accompanied by the shrinkage of the globe on the lower half of the cornea (fig. 3). Phthisis bulbi occurred in the right eye at month 3. A prosthesis was fit over the phthisis bulbi (fig. 4). An anterior segment examination of the left eye was unremarkable except for pupillary dilation. There was an upward and outward deviation of the left eye. Her eye movements were limited in all directions of gaze. Fundus examination revealed optic atrophy.


Bilateral traumatic globe luxation with optic nerve transection.

Tok L, Tok OY, Argun TC, Yilmaz O, Gunes A, Unlu EN, Sezer S, Ibisoglu S, Argun M - Case Rep Ophthalmol (2014)

Anterior segment ischemia and phthisis bulbi in the right eye.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296245&req=5

Figure 3: Anterior segment ischemia and phthisis bulbi in the right eye.
Mentions: Approximately 10 h after hospital admission, the patient underwent reduction of the globe into the orbit under general anesthesia. In the meantime, the globes were preserved and kept wet using artificial tear gel. Rather than a major surgery, it was planned to perform the reduction of the globe into the orbit because of the existence of bilateral transection in the optic nerves of the patient, visual hopelessness, posterior extraocular muscle rupture and the risk of not finding the ruptured muscles. During the operation, the socket was enlarged with lateral canthotomy, and then the globes were gently repositioned into the orbit with the assistance of an orbital plate and Desmarres lid retractor. The patient underwent bilateral temporary tarsorrhaphy, and a compression pad and bandage were applied. The compression closure was removed on day 3 and the tarsorrhaphy sutures on day 10. There was progressive and unresponsive edema in the right cornea. On the subsequent days, an ulcer developed, accompanied by the shrinkage of the globe on the lower half of the cornea (fig. 3). Phthisis bulbi occurred in the right eye at month 3. A prosthesis was fit over the phthisis bulbi (fig. 4). An anterior segment examination of the left eye was unremarkable except for pupillary dilation. There was an upward and outward deviation of the left eye. Her eye movements were limited in all directions of gaze. Fundus examination revealed optic atrophy.

Bottom Line: The right pupil was dilated and bilaterally did not react to light.The globes of the patient were bilaterally reduced into the orbit.Even if the luxated globe is repositioned into the orbit, there is still an increased risk of the development of phthisis due to ischemia.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Faculty of Medicine, Süleyman Demirel University, Isparta, Burdur, Turkey.

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.

No MeSH data available.


Related in: MedlinePlus