Globe luxation reduction

Background

• Extreme proptosis which permits lids to slip behind globe equator, obicularis oculi spasm sustains luxation
• Can be traumatic, spontaneous or voluntary
  • In spontaneous globe luxation, extraocular muscles and optic nerve generally remain intact.
  • In traumatic globe luxation, optic nerve avulsion is common (occurs in 38.2%)
• Early reduction indicated to relieve symptoms and minimize visual impairment

Indications

• Spontaneous or traumatic globe luxation

Contraindications

• Globe rupture (relative)

Procedure

• Perform rapid eye exam including visual acuity
• If traumatic, consider imaging to r/o orbital deformity, retrobulbar hemorrhage, etc
• Place patient in recumbent position
• Apply topical ocular anesthetic (e.g. tetracaine)
• When lashes are visible, have asst apply steady upward and outward traction to lids. If unable to grasp lashes, use lid retractor to apply countertraction
• With gloved fingers, gently apply scleral pressure and manipulate back into orbit
• Assess for and remove retained lashes to prevent corneal injury
• Repeat eye exam (acuity may not improve for days or longer)

Complications

• Retained lashes
• Failure to reduce (apply saline drops and non-contact eye shield)

Follow-Up

• Traumatic luxation requires emergent ophthalmology consult
• Spontaneous luxation (s/p reduction) with no visual impairment → follow up in 24-48 hours, avoid triggering maneuvers