Traumatic globe luxation associated with optic nerve avulsion is rare. We describe a case of a 42-year-old Indian gentleman who was involved in a motor vehicle accident (MVA). He sustained a deep laceration wound from the right side of the nose extending to the left medial canthal region and left eyelid. The left globe was not visualized, and only the left optic nerve stump was seen. A computerized tomography (CT) scan showed a left globe dislocated inferotemporal with discontinuity of the left optic nerve, inferior rectus, and lateral rectus muscle. There were also comminuted fractures at the floor and lateral wall of the left orbit with significant lateral displacement of the bone fragments. He underwent left eye enucleation, toilet, and suturing of the laceration wounds and open reduction internal fixation (ORIF) of the fractures. We report this case as it is not commonly seen in Malaysia.

A care algorithm for partial globe subluxation cases with optic nerve and at least one extraocular muscle (EOM) transection is presented after a literature review was performed using key term variations of globe, ocular, subluxation, optic nerve evulsion or transection, and trauma. Partial globe subluxation cases with transection of the optic nerve and at least 1 EOM were included. Exclusion criteria included globe rupture, complete enucleation defined by a globe without at least 1 EOM attachment, or unclear details confirming optic nerve transection. Including the patient presented herein, a total of 24 patients with 26 eyes were analyzed. About 73.08% of cases underwent initial repositioning (n = 19), with 11.54% of those requiring secondary enucleation or evisceration (n = 3). Of the secondarily managed cases, 2 of the 3 cases listed pain (n = 2) and inadequate cosmesis (n = 1) as rationale. We found that 26.92% of cases underwent initial enucleation (n = 7), citing lack of visual potential and limiting later complications. Most cases favored repositioning, which was typically sustainable. Initial repositioning can improve cosmetic outcome and psychological impact. Given the low risk of later management, cases of traumatic partial subluxation with EOM and optic nerve transections should attempt initial repositioning.

Ocular injury is one of the most important causes of vision loss. We present a case series of different ocular trauma cases with rare presentations which presented a great challenge to emergency management. The management of ocular injuries is a fight against time, with not only the vision but also at times present with the life of patients at risk. These thus require timely diagnosis. The first case involves a sharp penetrating injury with a metallic foreign body in the orbit. The second case is of a retained intraorbital foreign body secondary to a gunshot injury. The third case is of traumatic globe luxation secondary to a blunt injury. Lastly, the fourth case is of an animal bite with a lacerated wound. All the patients in the reported cases presented to the casualty of the Government Medical College, Haldwani. We believe this case series will add to the literature and help ophthalmologists gain experience dealing with such cases.

BACKGROUND: Globe luxation is rare and is mostly due to direct orbital trauma with fractures of the medial and floor walls, which displace the globe into the maxillary sinus. Only a few cases have been reported; moreover, patients who suffer global luxation rarely achieve eyesight recovery.
METHODS: This report describes the treatment and prognosis of global luxation occurring in a child. A 6-year-old boy presented with left globe luxation that occurred after a sudden stop on a tricycle, without any injury to the orbital or maxillofacial bony structures. After admission to the hospital, an external canthus incision, globe repositioning, orbital exploration and temporary blepharoplasty were performed. Finally, the child completely recovered and maintained good eyesight in his left eye even though the right eye developed myopia after four years of follow-up.
CONCLUSIONS: The aim of this study was to report the special occurrence of globe luxation in the child and share some experience of the treatment. Immediate surgical management plays an important role in the recovery of visual function, and globe luxation may prevent nearsightedness by reducing the distortion of the eyeball, shortening the axis and improving ciliary function.

We report a 57-year-old female with left globe enucleation following head trauma after falling. The left globe was intact and protruded from the orbit. A CT scan revealed anterior globe protrusion with avulsions of the optic nerve and the extraocular muscles with posterior-lateral dislocation of the left lateral orbital wall. Due to the unstable general condition (with signs of intracranial hemorrhage), the patient was admitted to the ICU, and the removal of the completely avulsed globe was postponed. After stabilizing the general condition, the avulsed globe with adjacent structures including a part of the optic nerve was removed in the operation theater and the patient was planned for future orbital reconstructive surgeries including ocular prosthesis. The patient underwent close follow-up visits during the admission for detecting any signs of sympathetic ophthalmia progression in the fellow eye. Traumatic enucleation is a rare condition and can be caused not only by direct and high-energy traumas, but also by the indirect mode of trauma with no significant orbital wall disassembly. In these patients, predisposition to globe luxation must be considered and advised for protecting the fellow eye from any traumas.

Clinical relevance: Traumatic globe luxation is rare vision-threatening event. Besides causing loss of vision in traumatised eye, it may also cause injury to contralateral optic nerve. Any such limitation in a one-eyed patient can make him crippled in his day-to-day activities. Here we hypothesise cause of contralateral field defect in such patients.Background: Traumatic globe luxation is a rare event that leads to profound vision loss due to injury of the ipsilateral optic nerve and rarely a visual field defect in the contralateral eye. Through this communication, we report similar case scenarios and intend to hypothesize the mechanism that results in the occurrence of the contralateral visual field defect.Methods: It is a retrospective, observational study. All cases with traumatic globe luxation were enrolled. Visual field analysis of the contralateral normal eye was main outcome measure.Results: Four patients with traumatic globe luxation and optic nerve injury were studied. There was complete loss of vision in the traumatised eye in all the patients. One patient had complete transection of the optic nerve, whereas in three patients, the course of the optic nerve was intact, on imaging. Three patients had quadrantanopia in the contralateral normal eye for which oral steroids were given. At 1-month follow-up, there was complete recovery of the visual field defect in two patients. We noticed that all the three patients with an intact course of the ipsilateral optic nerve had quadrantanopia in the contralateral normal eye.Conclusion: We hypothesize that in scenarios where globe luxation is associated with incomplete transection or no transection of the optic nerve, a continuous long standing stretch on the optic nerve, transmits the pulling force to the chiasma which might result in a contralateral field defect as compared to those associated with the complete transection of the optic nerve.

Traumatic eyeball luxation is a rare clinical condition with a dramatic presentation. Here, we describe a unique case of traumatic globe luxation and complete optic nerve transection caused by heavy object compression. A 45-year-old male automobile mechanic was injured when a truck slipped from its supports, crushing his head and face. On arrival, his right eyeball was obviously displaced anteriorly and he had no light perception. Computed tomography revealed complex frontal bone and facial fractures with underlying brain contusion in addition to complete transection of the right optic nerve. The patient was successfully treated using a multidisciplinary approach.

OBJECTIVE: We report a rare case of spontaneous eyeball luxation associated with exophthalmos due to iatrogenic Cushing syndrome (CS). The normalization of serum hormones led to the regression of the picture.
METHODS: A 64-year-old man presented with spontaneous globe luxation of the left eye after a 6-month history of bilateral, painless, and slowly progressive exophthalmos. The patient had been receiving weekly infusions of methylprednisone over the previous 6 months. His best-corrected visual acuity (BCVA) at presentation was 20/40 in the right eye and 20/20 in the left eye. The patient demonstrated full extraocular motility. The intraocular pressure (IOP) was elevated in the right eye (24 mHg) and normal in the left eye (18 mmHg). Exophthalmometry demonstrated bilateral proptosis with measurements of 27 mm in the right eye and 28 mm in the left eye. Computed tomography scan of the brain and orbits revealed increased orbital and cervical fat. Clinical, radiographic and serologic findings ruled out potential diagnoses including orbital metastasis, thyroid orbitopathy, carotid-cavernous fistula, and idiopathic orbital pseudotumor. Clinical suspicion of iatrogenic CS was high, and additional serologic testing confirmed the diagnosis.
CONCLUSIONS: Exophthalmos is an uncommon sign of CS, but to our knowledge, this is the first reported case of spontaneous globe luxation secondary to CS. In our case, normalization of cortisol was sufficient to resolve the clinical symptoms and eliminated the need for surgical intervention such as orbital decompression surgery.

OBJECTIVE: To describe the results of orbital decompression in patients with spontaneous globe luxations and to evaluate predisposing factors for this condition.
METHODS: The clinical records of patients who underwent orbital decompression for the treatment of spontaneous globe luxations between 2010 and 2013 were reviewed. Data collected were age, gender, predisposing factors, preoperative and postoperative exophthalmometry, duration of follow-up, presence of diplopia before and after surgery and intra- and postoperative complications.
RESULTS: Seven patients underwent orbital decompression after spontaneous globe luxation during the study period. Six patients underwent bilateral decompression. Two patients underwent a three-wall decompression, four of them medial and lateral decompression and one patient medial decompression. The predisposing factors for globe luxation were Graves\' orbitopathy, malar hypoplasia, high myopia, floppy eyelid syndrome and orbital fat hypertrophy in the context of obesity. After orbital decompression, none of the patients reported new globe luxations. No intraoperative complications were observed. None of the patients developed de novo diplopia.
CONCLUSIONS: Orbital decompression is an effective method for the prevention of new episodes in patients with spontaneous globe luxations. It has good aesthetic and functional results and addresses the exophthalmos present in most cases.

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.