Immediate Surgical Management of Traumatic Dislocation of the Eye Globe into the Maxillary Sinus: Report of a Rare Case and Literature Review

Abstract

We report a case of complete dislocation of the globe into the maxillary sinus, with immediate repositioning of the globe. This report highlights the importance of early surgical repair of orbital fracture and globe repositioning to regain the maximum amount of ocular functions. A review of literature found 19 cases of globe dislocation into the maxillary sinus: One case was enucleated 2 months after misdiagnosis as traumatic enucleation, six cases were documented no vision or no light perception, three cases did not have reported vision (patients did not survive), and nine cases with postoperative vision. We recommend early surgical intervention to restore the cosmetic and visual function of the dislocated eye.

Keywords: eye; globe dislocation; optic nerve; orbital fracture.

Fig. 1

(a) Periorbital hematoma and skin laceration of the upper right eyelid. (b) Manual opening of the eyelid without any evidence of the eyeball (anophthalmic right orbital cavity).

Fig. 2

Preoperative coronal and axial computed tomography scan images showing the right globe completely dislocated into the maxillary sinus.

Fig. 3

(a) Antrostomy by 8 mm diameter atraumatic dome-shaped sinus lateral window bur. (b) The globe (arrow) completely dislocated and contained within the right maxillary sinus.

Fig. 4

(a) Gloved finger (arrow) introduced inferiorly from the maxillary sinus protruding through orbital floor defect. (b) Right globe repositioned within the orbital cavity.

Fig. 5

(a) Titanium mesh reconstruct orbital floor defect. (b) Second mesh applied through antrostomy to support the globe posteriorly. (c) Maxillary antrostomy repaired by titanium mesh.

Fig. 6

Postoperative coronal and axial CT scan images showing good repositioning of the globe. Coronal CT scan images showing the posterior extent of the reconstructed defect. CT, computed tomography.

Fig. 7

Postoperative appearance after repositioning of the right globe with good cosmetic outcome.