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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Related Studies

Ontology: Luxation of eye (C0154806)

Concepts Disease or Syndrome (T047)
ICD9 360.81
ICD10 H44.82
SnomedCT 20842008
Italian Lussazione oculare, Lussazione del globo oculare
Dutch verplaatsing van bol, luxatie; oog, oog; luxatie, oogluxatie
French Luxation du globe, Luxation oculaire
Portuguese Luxação do globo ocular, Luxação do olho
Spanish Luxación del globo ocular, luxación del globo ocular (trastorno), luxación del globo ocular, Luxación del ojo
Japanese 眼の脱臼, 眼球の脱臼, メノダッキュウ, ガンキュウノダッキュウ
English luxation of globe (diagnosis), luxation of globe, Eye luxation, Luxation of globe, Luxation of eye (disorder), Luxation of eye, dislocation; eye, eye; dislocation
Czech Luxace oka, Luxace bulbu
Hungarian Szem luxatio, Szemgolyó luxatiója
German Luxation des Augapfels

Ontology: Luxation of globe, unspecified eye (C2881207)

Concepts Disease or Syndrome (T047)
ICD10 H44.829
English Luxation of globe, unspecified eye