Traumatic Globe Enucleation After Blunt Head Injury

Abstract

We report a 57-year-old female with left globe enucleation following head trauma after falling. The left globe was intact and protruded from the orbit. A CT scan revealed anterior globe protrusion with avulsions of the optic nerve and the extraocular muscles with posterior-lateral dislocation of the left lateral orbital wall. Due to the unstable general condition (with signs of intracranial hemorrhage), the patient was admitted to the ICU, and the removal of the completely avulsed globe was postponed. After stabilizing the general condition, the avulsed globe with adjacent structures including a part of the optic nerve was removed in the operation theater and the patient was planned for future orbital reconstructive surgeries including ocular prosthesis. The patient underwent close follow-up visits during the admission for detecting any signs of sympathetic ophthalmia progression in the fellow eye. Traumatic enucleation is a rare condition and can be caused not only by direct and high-energy traumas, but also by the indirect mode of trauma with no significant orbital wall disassembly. In these patients, predisposition to globe luxation must be considered and advised for protecting the fellow eye from any traumas.

Keywords: auto enucleation; globe avulsion; globe luxation; traumatic enucleation; traumatic globe avulsion.

Figure 1. Total overhanging of the left globe from the orbit. The globe did not have any obvious lacerations

Figure 2. (A) Axial orbital CT scan showed left lateral orbital wall dislocation to the posterior-lateral side. (B) Axial brain CT scan revealed a left-sided subarachnoid hemorrhage

CT, computed tomography.

Figure 3. The removed necrotic and auto-enucleated globe