Traumatic Globe Subluxation and Intracranial Injury Caused by Bicycle Brake Handle

Abstract

Introduction: Penetration of a bicycle brake handle into the orbit is a rare and serious type of trauma. Globe subluxation due to such trauma has not been previously reported.

Case presentation: A 10-year-old girl presented after falling from a bicycle, which resulted in the handbrake penetrating her right upper eyelid. On examination, the globe was subluxated anteriorly, there was no light perception, and the pupilla was fixed and dilated. Radiologic studies revealed orbitonasal fractures, hemorrhage, emphysema in the orbit and cranium, and rupture of the extraocular muscles. The globe was replaced into the orbit with the help of lateral cantholysis and orbital septotomy. During 22 months of follow-up, the globe remained intact, but total loss of vision, blepharoptosis, and extraocular motility restriction persisted.

Conclusions: This case and previous reports show that bicycle brake handles can cause severe, penetrating orbital and cerebral traumas that can result in vision loss or fatality. Brake handles should be designed to protect bicyclists from such injuries.

Keywords: Brain Injuries; Child; Extraocular Muscle; Optic Nerve Injuries; Orbital Fracture.

Figure 1.. Globe Subluxation and Intracranial Injury Due to Bicycle Brake Handle Penetration Through the Upper Eyelid

A, Globe subluxation in a 10-year-old child as a result of bicycle handbrake penetration into the orbit; B, Lateral view of the patient; C, Computed tomography showing sphenoidal fracture in the apical orbit, medial rectus rupture, intracranial and intraorbital hemorrhage, and air in association with globe subluxation; D, The globe was repositioned into the orbit after lateral cantholysis and orbital septotomy; E and F, Six months after the trauma, the globe maintained its integrity. Ptosis and eye movement restriction persisted.