Missing Globe: A Case of Severe Head Trauma, Eyelid Laceration, and Traumatic Enucleation

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Abstract

We report an unusual periocular injury in a 19-year-old motorcycle rider during an accident. The patient had lacerations on the right upper and lower eyelids and the globe was enucleated en bloc. Despite disorganization of the eyelids and orbit, reconstruction of the eyelids and anophthalmic socket was successful. The primary reconstruction of the anophthalmic socket in the traumatic enucleation is a real challenge, especially when the conjunctival and the orbital tissues are missing or disorganized. It is proposed to utilize the optic nerve regeneration techniques in the cases of traumatic enucleation when the globe is intact. However, in the current case, the globe was unavailable.

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Most cited references 5

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Update on Sympathetic Ophthalmia

J. Arevalo, Reinaldo Garcia, Hassan Al-Dhibi … (2012)

Sympathetic ophthalmia (SO) is a bilateral diffuse granulomatous intraocular inflammation that occurs in most cases within days or months after surgery or penetrating trauma to one eye. The incidence of SO ranges from 0.2 to 0.5% after penetrating ocular injuries and 0.01% after intraocular surgery. Vitreoretinal surgery and cyclodestructive procedures are considered risk factors. The time from ocular injury to onset of SO varies greatly, ranging from a few days to decades, with 80% of the cases occurring within 3 months after injury to the exciting eye and 90% within 1 year. The diagnosis is based on clinical findings rather than on serological testing or pathological studies. It presents as a bilateral diffuse uveitis. Patients report an insidious onset of blurry vision, pain, epiphora, and photophobia in the sympathizing, non-injured eye. Classically this is accompanied by conjunctival injection and a granulomatous anterior chamber reaction with mutton-fat keratic precipitates (KPs) on the corneal endothelium. In the posterior segment, the extent of inflammation can vary. Systemic corticosteroids are the first line therapy for SO. If patients are non-responsive to steroid therapy or have clinically significant side effects, cyclosporine, azathioprine or other immunosuppressive agents can be used for long-term immunomodulatory therapy.

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The prevalence and 5-year incidence of ocular trauma. The Beaver Dam Eye Study.

John Klein, Marina Klein, Joseph Wong (2000)

To describe the cumulative lifetime prevalence and 5-year incidence of ocular trauma and their relation to risk factors in a defined white adult population living in a small town. Population-based cross-sectional and follow-up study. Participants aged 43 to 86 years from the baseline Beaver Dam Eye Study that took place from 1988 through 1990 (n = 4926) and the follow-up study that took place from 1993 through 1995 (n = 3684). Standardized interview at baseline and follow-up study. Cumulative lifetime prevalence and 5-year incidence of self-reported history of ocular trauma. The cumulative lifetime prevalence and 5-year incidence of ocular trauma was 19.8% (n = 972) and 1.6% (n = 57), respectively. A history of trauma in both eyes was reported in 15% of the prevalent cases and 8% of the incident cases. Sharp objects caused more than half of all injuries. Persons aged 43 through 54 years were 2.5 times more likely to have a lifetime history of ocular trauma than persons aged 75 and older (odds ratios [OR], 2.57; 95% confidence interval [CI], 2.0, 3.29). Males had four times the prevalence of females (OR, 4. 42; 95% CI, 3.79, 5.16). Almost one third of all males aged 43 through 54 years reported a history of ocular trauma in their lifetime. The higher risks in the 43 through 54 age group (OR, 1.60) and male gender (OR, 1.42) were not significant among incident cases. In multivariate analysis, blue collar (adjusted OR, 1.58; 95% CI, 1. 32, 1.89) and farm-related workers (adjusted OR, 1.32; 95% CI, 0.93, 1.87) had higher lifetime risks of ocular trauma compared with white collar workers. People with a history of fractures also had increased lifetime risks (adjusted OR, 1.30; 95% CI, 1.13, 1.52). A history of ocular trauma reported in the baseline examination was significantly associated with a higher risk of ocular trauma occurring again in the next 5 years (adjusted OR, 3.27; 95% CI, 1.76, 5.82), especially if both eyes had previous trauma (adjusted OR, 5.15; 95% CI, 2.03, 13.0). One fifth of white adult Americans more than 42 years of age residing in a small town reported ocular trauma in their lifetime. This group had a three times higher risk of experiencing ocular trauma again within 5 years.

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Traumatic globe luxation associated with orbital fracture in a child: a case report and literature review.

Márcio Amaral, Matheus Carvalho, André Ferreira … (2015)

Orbital fracture associated with traumatic globe luxation is rare, as it generally requires trauma with high energy for this to occur. The present case report focused on a child who had been hit by a motorcycle, leading to a globe luxation of the left eye and fractures of the superolateral orbital walls. The patient presented initial cosmetic and psychological benefits from the repositioning of the intact globe and the reduction of the orbital fractures. However, a subsequent evisceration of the globe was required due to persistent proptosis and pain. An ocular prosthesis was also implanted, thus recovering the patient's aesthetics. Thirty-four well-documented cases of traumatic globe luxation could be found in the English literature since 1970. The mean age of patients presenting traumatic globe luxation was 29.5 years. The male gender proved to be more prevalent, with traffic collisions representing the most common accident etiology. Direct orbital trauma with fractures of medial and floor walls displacing the globe into the maxillary sinus represented the most common injury mechanism (38.2 %), followed by an elongated object entering the orbit (26.5 %). Optical nerve avulsion is the most serious complication seen in association with traumatic globe luxation, with the repositioning of the initial globe, with no enucleation or evisceration, representing the main form of management.

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Author and article information

Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 26 December 2017

Publication date (Electronic, collection): December 2017

Volume: 9

Issue: 12

Electronic Location Identifier: e1988

Affiliations

[1 ] Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Science (Iums)

[2 ] St. Erik Eye Hospital, Stockholm, Sweden., St. Erik Eye Hospital

[3 ] Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Science (iums), Tehran, Iran

Author notes

Joobin Khadamy joobin.khadamy@ 123456gmail.com

Article

DOI: 10.7759/cureus.1988

PMC ID: 5826743

SO-VID: 6827e30d-89b9-42ec-afdf-565b49d31419

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 6 December 2017

Date accepted : 26 December 2017

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