II. Definitions

  1. Globe Luxation
    1. Complete or partial globe prolapse from orbit

III. Causes

  1. Trauma
  2. Spontaneous
    1. Valsalva
    2. Contact Lens insertion or removal
    3. Predisposition
      1. Graves Exophthalmos
      2. Shallow Orbit (e.g. Apart Syndrome)

IV. Exam

  1. See Eye Evaluation in Trauma
  2. Protect globe without globe contact with shield or other protection

V. Management: Globe Reduction

  1. Precautions
    1. Avoid delays if no contraindication to reduction
    2. Delayed reduction risks complications (see below)
  2. Contraindications
    1. Ruptured Globe
    2. Associated injuries requiring surgical management (e.g. Facial Fracture, Retrobulbar Hematoma)
  3. Preparation
    1. Topical Anesthetic (e.g. tetracaine)
    2. Consider anxiolysis (e.g. IV Benzodiazepine)
    3. Consider Procedural Sedation (awake patient is preferred)
  4. Technique: Step 1 - Move globe equator past the upper Eyelid
    1. Patient maintains upright head while looking downward
    2. Examiner (or assistant) pinches upper Eyelid and lifts upward as much as possible
      1. Eyelid retractor may be used if available
      2. Suture may be placed for lid retraction if Eyelid cannot be grasped or the lashes cannot be seen
    3. Examiner applies finger at upper Sclera
      1. Apply gentle downward and backward pressure on the globe
      2. Apply pressure only to the Sclera (NOT the Cornea)
      3. Continue until the globe equator is past the upper Eyelid
  5. Technique: Step 2 - Reduce globe back into orbit
    1. Upper Eyelid retraction upward is continued
    2. Patient looks upward
      1. Should allow the globe to rotate back into orbit under Eyelid
  6. Technique: Step 3 - Completion
    1. Reposition lower lid malpositioning
    2. Examine globe surface and fornices for foreign body or eyelash
    3. Repeat Eye Exam (see Eye Evaluation in Trauma)

VI. Complications

  1. Globe or Retinal ischemia
  2. Traumatic optic Neuropathy
  3. Exposure Keratopathy
  4. Corneal Abrasion

VII. References

  1. Warrington (2018) Crit Dec Emerg Med 32(12): 12-3
  2. Boesoirie (2021) Traumatic Globe Luxation, Eye Wiki, accessed 11/30/2021
    1. https://eyewiki.aao.org/Traumatic_Globe_Luxation

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