A 25-year-old female patient was admitted to the emergency service with multiple traumas following a motor vehicle accident. The patient was reported to have been riding in the back seat of the vehicle without the safety belt fastened when the vehicle rolled down an embankment. The patient was conscious but agitated. Bilateral globes were completely out of their sockets (fig. ). During examination, the right pupil was dilated and bilaterally did not react to light. The patient had no light perception bilaterally. The right globe was intact in appearance but hypotonic. The anterior segment of the left globe was normal; however, the right fundus could not be visualized. The left eye fundus examination revealed patches of hemorrhage around the optic disk. The patient had deep cuts of 4 cm towards the right lateral section of the upper lip and 5 cm on the lower jaw.
Visual acuity testing showed no light perception. The right pupil was dilated and bilaterally did not react to light. The globes were bilaterally intact. A computed tomography scan revealed Le Fort type II fractures, bilateral optic nerve transection and disruption of all extraocular muscles. The globes of the patient were bilaterally reduced into the orbit. However, the patient developed phthisis bulbi in the right eye at month 3.
Z97.13 Presence of artificial right leg (complete) (partial)
In globe luxation, the extraocular muscles and optic nerve can be affected at different levels. The extraocular muscles and optic nerve can remain intact, as in patients with spontaneous globe luxation; or they can be damaged at different levels of severity, as in most patients with traumatic globe luxation. The presence of optic nerve avulsion worsens the prognosis. There can be partial or complete avulsion of the optic nerve. In cases of complete optic nerve avulsion, the optic sheath, which is more elastic than the optic nerve, usually remains attached to the globe and the optic nerve may appear normal . Thus, the clinician should consider this in a patient with vision loss. Even though the lamina cribrosa is anatomically the weakest part, optic nerve transection 30–50 mm behind the globe has been reported in most well documented cases of globe luxation [, ]. In the case presented here, there was a transection 25 mm behind the globe in the right eye, and 20 mm behind the globe in the left eye, and the optic nerve was found to have been retracted behind the globe. In globe luxation, extraocular muscle loss accompanies almost all cases of nerve damage. The most commonly avulsed extraocular muscles are, in descending order of frequency, medial, inferior, superior, lateral rectus and oblique. The muscles that are most easily found inside the Tenon's capsule, and can be sutured back to their original insertions, are superior, inferior and lateral rectus. In this case, all extraocular muscles of both eyes were avulsed, except for the superior and lateral rectus of the left eye.