Traumatic Globe Luxation and Optic Nerve Avulsion: A Case Report and Literature Review

Abstract

Traumatic globe luxation associated with optic nerve avulsion is rare. We describe a case of a 42-year-old Indian gentleman who was involved in a motor vehicle accident (MVA). He sustained a deep laceration wound from the right side of the nose extending to the left medial canthal region and left eyelid. The left globe was not visualized, and only the left optic nerve stump was seen. A computerized tomography (CT) scan showed a left globe dislocated inferotemporal with discontinuity of the left optic nerve, inferior rectus, and lateral rectus muscle. There were also comminuted fractures at the floor and lateral wall of the left orbit with significant lateral displacement of the bone fragments. He underwent left eye enucleation, toilet, and suturing of the laceration wounds and open reduction internal fixation (ORIF) of the fractures. We report this case as it is not commonly seen in Malaysia.

Keywords: enucleation; globe luxation; le fort fracture; motor vehicle accident; optic nerve avulsion.

Figure 1. Intraoperative view showing left globe missing with only optic nerve stump seen (blue arrow). There was a deep laceration wound from the right side of the nose extending to the left medial canthus and the upper and lower left eyelid (black arrow)

Figure 2. CT scan showing left globe luxation inferotemporally (blue arrow). The globe was intact.

Figure 3. CT scan (coronal view) showing left globe luxation inferotemporally (blue arrow) with fracture over the floor and the lateral wall of the left orbit.

Figure 4. Post left eye enucleation, toilet, and suturing of laceration wound and left temporary tarsorrhaphy.