Luxation of the globe is a rare event whereby the eyelids slip
behind the midcoronal plane of the eye in an extremely proptosed
eyeball (Figure 140-1). The orbicularis oculi muscle then goes into spasm,
which maintains the luxation of the globe. Extraocular eye movements
become severely limited. The optic nerve and retinal vasculature
are subjected to an abnormal amount of traction, resulting in possible
damage to these structures or the retina.1
The luxated globe. A. Superior
view. B. Lateral view.
There are three major causes of globe luxation: spontaneous,
voluntary, and traumatic. Spontaneous luxation tends to occur in
individuals with shallow orbits.2 Structural abnormalities—such
as laxity of the supporting muscles and fascia as well as anomalous
extraocular muscles—can predispose to spontaneous luxation.2–4 Pathologic
processes that cause proptosis can predispose to luxation. The literature
documents cases of luxation associated with orbital tumors, Graves’ disease,
cerebral gummas, histiocytosis X, and craniofacial dysostosis.1,5,6 Voluntary
luxation occurs in individuals who learn to cause globe propulsion
by using a digit or use of their extraocular muscles. Some
patients use a Valsalva maneuver to luxate their globe(s) voluntarily.
Traumatic luxation results from trauma to the globe or the surrounding
bony orbit. It can occur from motor vehicle accidents or even relatively
minor trauma to the face.7,8 Traumatic luxation can also
occur from intentional eye gouging or even during the forceps-assisted
delivery of a neonate.9,10
The normal anatomic relationship of the globe to the surrounding
structures is seen in Figure 140-2. The midcoronal plane of the
eye is a transverse section through the eye in the coronal plane.
It is through the widest portion of the eye and divides the eye
into anterior and posterior halves. When the eyelids get behind
the midcoronal plane, the orbicularis oculi muscle is pulled taut
and begins to go into spasm. This spasm prevents spontaneous reduction
of the globe.
Anatomy of the eye and orbit.
Globe reduction is indicated to relieve traction on the optic
nerve and retinal vessels. The patient’s visual acuity
has the potential of being compromised without prompt reduction.
Sustained globe luxation is physically and psychologically uncomfortable
for the patient, may result in permanent loss of vision, and is
difficult to reduce without general anesthesia.
Obvious rupture of the globe and extensive orbital fractures
that require immediate surgical intervention are relative contraindications
to globe reduction. Edema and retrobulbar hemorrhage can make reduction
outside the Operating Room impossible.1,6
- Topical ocular anesthetic (0.5% proparacaine
or 0.5% tetracaine)
- Sterile gauze and gloves
- Sutures or eyelid retractors
- Local anesthetic solution (1% lidocaine), if eyelid
retaining sutures need ...
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