Eye Inside Out: Endonasal Endoscopic Reposition of Eye from Nose with Complete Vision Regainment

Abstract

Faciomaxillary and ocular trauma is a common entity in most emergency and trauma units. We came across a 68-year-old female patient with a history of bull horn injury over the right eye. Examination revealed an empty orbital socket with unreliable perception of light present. Imaging showed that the eye had displaced posteroinferomedially to be lying in the ethmoid air cells in the nasal cavity. Under nasal endoscopic guidance, the eye was reposited back into the orbital socket and conjunctival sutures were taken to stabilize the position. The patient had vision of counting fingers at 1.5 m on the first postoperative day which improved to 6/24 on last follow-up. Such is the rarity that never before has such a case been described in literature where traumatic displacement of eyeball into the nose has been successfully repositioned by an endonasal endoscope with appreciable regaining of vision. It also further promotes endonasal endoscopic approach in the management of orbital blow out injuries.

Keywords: bull horn injury; endonasal endoscopic repair; medial orbital blow out; ocular trauma.

Fig. 1

Presenting image of patient where the right orbital socket is empty.

Fig. 2

Coronal CT scan of the orbit showing posteroinferomedial displacement of the right eyeball into the nasal cavity.

Fig. 3

Axial CT scan of the orbit showing posteroinferomedial displacement of the right eyeball into the nasal cavity.

Fig. 4

Schematic image of the operative intervention by pushing the globe laterally using the Freer elevator and pulling it by the loop suture attached to the lateral rectus muscle.

Fig. 5

On table findings of the right eye after successful reposition of the globe.

Fig. 6

Patient's condition at 8 months postoperative period.

Fig. 7

Axial CT scan of orbit showing normally placed eyeball with healed ethmoid fracture at 8-month follow-up.

Fig. 8

Coronal CT scan of orbit showing normally placed eyeball with healed ethmoid fracture at 8-month follow-up.