Globe luxation reduction


  • 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.[1]
    • In traumatic globe luxation, optic nerve avulsion is common (occurs in 38.2%)[2]
  • Early reduction indicated to relieve symptoms and minimize visual impairment


  • Spontaneous or traumatic globe luxation



  • Perform rapid eye exam including visual acuity
  • If traumatic, consider imaging to rule out 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)


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


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


  1. Tok L, Tok OY, Argun TC, et al. Bilateral Traumatic Globe Luxation with Optic Nerve Transection. Case Reports in Ophthalmology. 2014;5(3):429-434. doi:10.1159/000370043.
  2. Amaral MB, Carvalho MF, Ferreira AB, Mesquita RA. Traumatic globe luxation associated with orbital fracture in a child: a case report and literature review. J Maxillofac Oral Surg. 2015 Mar;14(Suppl 1):323-30.