globe subluxation

15 Apr

Nice tidbit from this month’s EP Monthly:

GLOBE SUBLUXATION: Rare condition, nice to know how to fix it.  

TRIGGERS:

  • manipulation (e.g. spreading lids to put in contacts)
  • coughing
  • vomiting
  • straining/other valsalva
  • extremes of gaze

COMPLICATIONS:

  • exposure keratopathy
  • corneal abrasion
  • traumatic optic neuropathy

HOW DO I FIX IT ALREADY?

  • topical anesthetic drops (good for dry eyes, blepahrospasm, pain)
  • manual reduction
    • gentle pressure on globe (along sclera, not the cornea)
    • pull lids anteriorly from behind the globe
  • assisted reduction with down/up gaze
    • have patient look downward
    • pull/lift upper eyelid over globe with retractor/paper clip bent at 90 degrees/your healing hands)
    • gently push the globe posterior and inferior (your finger is on the superior sclera)
    • have patient look up, as you pull the eyelid over the eye
    • presto, you’ve fixed it (hopefully)
  • sedation may be necessary in some

References: epmonthly article; picture

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