Traumatic globe subluxation: An overview of two cases, management and literature review

Globe subluxation is an uncommon presentation in the emergency department with the diagnosis usually clinical, the prolapsed globe being visible easing diagnosis. Here, we report two case presentation of globe subluxation. Case 1- A 39 year old female presented with a day history of trauma to the right eye, severe eye pain and anxiety. Examination showed vision was Counting Fingers at 1meter in the right eye and 6/6 in the left eye, right eye lid swelling with the globe displaced anteriorly, conjunctival injection, mild corneal edema, deep anterior chamber, sluggish pupil and poor fundal view. Initial manual reduction attempt was aborted as patient was uncomfortable and uncooperative from pain in the right eye. Further examination with reduction was achieved under general anesthesia. First day post reduction vision was 6/24 with residual hypotropia. Anterior segment showed resolved corneal edema with improved pupillary reaction. She was referred to the strabismus unit for possible strabismus correction but neither honoured said referral nor returned for follow up review. Case 2- A 12 year old pupil presented with a twelve-hour history of trauma to the right globe by a nail, severe eye pain, swelling, loss of vision and anxiety. Upon examination, vision was Counting Fingers at less than three meters. The globe was displaced anteriorly, a nail imprint visible beneath the brow. There was mild corneal epithelial haze and pupil was sluggish. The globe was manually reduced and temporary tarsorrhaphy applied following anaesthesia with topical proparacaine in the conjunctiva and subcutaneous infiltration of xylocaine. Topical Anti-inflammatory, anti-microbial and lubricants were commenced. Eyelid edema resolved and visual acuity improved to 6/24 within 48 hours. Patient steadily improved and by 6th day, Vision was 6/5, with residual subconjunctival hemorrhage, briskly reacting pupil, normal disc and retina findings. At day 14, subconjunctival hemorrhage was completely resolved. Globe subluxation can be very distressing to the patient and can lead to reduction in vision and permanent visual morbidity. Prompt identification and globe reduction leads to good outcome for globe structure and function.