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Traumatic eye ball luxation: A stepwise approach to globe salvage

机译:外伤性眼球脱位:抢救地球仪的逐步方法

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摘要

Craniofacial trauma is often associated with orbital and ocular injuries. We report a case of a 21-year-old male with motor vehicular accident, orbital roof blow-in fracture, cerebrospinal fluid (CSF) leak, and left sided globe luxation with corneal abrasion and complete conjunctival denuding. The patient was managed by a multispeciality team and the eyeball was protected by amniotic membrane graft (AMG) biological dressing with novel use of inverted sterile metallic bowl as mechanical protection till the patient stabilized. During surgery, eyeball was reposited and ocular surface was reconstructed using amniotic membrane and symblepharon ring. Surgical correction and plating of the facial fractures and dural repair with autologus tensor fascia lata was done. Post surgery ocular surface was intact, ocular motility was well preserved and the globe was prephthisical. Traumatic eyeball luxation is a rare, but dramatic presentation which may occur in a blow in fracture when the intra orbital volume reduces and expels the eye ball out of the socket. This may be associated with extra ocular muscle rupture or optic nerve avulsion. The visual prognosis is nil in majority cases. However, the management is targeted towards globe preservation in view of psychological benefit and ease of cosmetic or prosthetic rehabilitation. Knowing the mechanism of luxation helps to plan the management. A stepwise approach for globe salvage is recommended. Team efforts to take care of various morbidities with special steps to safeguard the eye help to optimize outcomes.
机译:颅面创伤通常与眼眶和眼部损伤相关。我们报告了一例21岁的男性,其中有机动车辆事故,眼眶房顶骨折,脑脊液(CSF)泄漏,左侧眼球脱位伴角膜擦伤和结膜剥脱。该患者由一个多专业团队管理,并通过羊膜移植物(AMG)生物敷料保护眼球,并采用倒置无菌金属碗作为机械防护,直到患者稳定为止。在手术过程中,使用羊膜和symblepharon环重建眼球并重建眼表。进行了自体张量筋膜筋膜的外科矫正和面部骨折的镀层以及硬膜修复。手术后眼表完好无损,眼球活动力得到很好的保护,眼球是早发的。外伤性眼球脱位是罕见的,但戏剧性的表现,当眼眶内体积减小并将眼球从窝中推出时,可能会发生骨折破裂。这可能与眼外肌破裂或视神经撕脱有关。在大多数情况下,视觉预后为零。但是,考虑到心理上的好处以及美容或假肢康复的便利性,管理层的目标是保护眼球。了解脱位的机制有助于计划管理。建议采用分步方法进行地球仪打捞。团队采取各种特殊措施来保护眼睛,以保护各种疾病,从而有助于优化结果。

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