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CASE REPORT |
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Year : 2016 | Volume
: 9
| Issue : 6 | Page : 747-749 |
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Posttraumatic herniation of eyeball: A rare case
Sachin Parshuram Guthe1, Poonam Darade2, Pravin Survashe1, Vernon Velho1
1 Department of Neurosurgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India 2 Department of Radiology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
Date of Web Publication | 16-Nov-2016 |
Correspondence Address: Sachin Parshuram Guthe "Shrikant," C/O P. D Guthe, Sant Sena Nagar, Behind Jayakwadi Office, Parbhani - 431 401, Maharashtra India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.194205
Posttraumatic herniation of the eyeball is very rare. There are very few prior reported cases of herniation of eyeball into the maxillary sinus. We hereby add one more case to literature of posttraumatic fracture of floor of the orbit and herniation of the eyeball into the maxillary sinus which was diagnosed on computed tomography scan. Keywords: Eyeball, herniation, maxillary sinus, orbital, trauma
How to cite this article: Guthe SP, Darade P, Survashe P, Velho V. Posttraumatic herniation of eyeball: A rare case. Med J DY Patil Univ 2016;9:747-9 |
Introduction | | |
Eye injury covers a broad range of severity, from small corneal abrasion to the more severe penetrating and globe rupture injuries. Ocular injury is a frequent and preventable cause of visual impairment. Traumatic dislocation of the globe is known but a rare entity which requires careful assessment and treatment. In our case, there was posttraumatic herniation of eyeball into maxillary sinus which was diagnosed on computed tomography (CT). To the best of our knowledge, there are very few prior reported cases of herniation of eyeball into maxillary sinus. [1],[2],[3] This is the rare case of herniation of eyeball.
Case Report | | |
A 55-year-old male, construction site worker was brought to the emergency department with a history of head injury. He sustained head injury due to fall of a heavy object, a mixture of wood and cement, on his forehead. This foreign body penetrated his left orbit and was noted in the left orbit [Figure 1]. | Figure 1: Preoperative photograph of patient showing black colored foreign body penetrated into left orbit
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He had complaints of a headache, loss of vision in left eye, watery discharge from left orbit. He did not have vomiting, seizure, loss of consciousness.
On general examination, he was conscious, drowsy but was oriented to time, place, person. His vitals were stable with pulse rate of 68/min and blood pressure of 110/78 mmHg. His Glasgow coma scale score was 14/15 (E3M6V5).
A local examination revealed large brownish-black colored foreign body in left orbit, and there were multiple lacerations on left forehead and the supraorbital area including eyelids [Figure 1]. The left eyeball was missing from the socket and left orbit was anophthalmic. Extraocular muscles were found to be disrupted. Right eye vision was preserved with visual acuity of 6/6.
After initial assessment, he was stabilized, broad spectrum antibiotics (cefotaxime and amikacin) were administered, and CT head with orbit was obtained. CT scan revealed a hyperdense foreign body in the left orbit; it was extending intracranially through optic foramina, surrounding basifrontal brain contusions, and extensive pneumocephalus. There were blowout fractures of left orbital floor and medial wall. The left eyeball was seen herniated into the left maxillary sinus through fractured orbital floor [Figure 2]. Complete transaction of the left optic nerve was seen at orbital apex [Figure 3]. | Figure 2: Coronal sections of computed tomography brain with orbit showing herniation of left eyeball into left maxillary sinus through fractured orbital floor
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| Figure 3: Computed tomography brain with bony window showing complete transaction of left optic nerve at orbital apex
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After primary evaluation by a neurosurgeon and an ophthalmologist, he was posted for emergency debridement, repair of laceration, and removal of foreign body. Intraoperatively left orbit was fully occupied by the foreign body and the eyeball was not seen in the left orbit. With gentle dissection, foreign body was separated and delivered out [Figure 4]. Herniation of left eyeball into the left maxillary sinus was seen. It was delivered out with gentle dissection. However, there was no continuity of the left optic nerve with eyeball hence eyeball was removed. The small dural tear was noted which was sutured. Thorough saline, antibiotics, hydrogen peroxide wash, was given. Lacerations were repaired. Postoperatively, he recovered well and the wound healed well [Figure 5]. There was no cerebrospinal fluid leak from orbit. He was planned for reconstruction of the orbit with the artificial eyeball. | Figure 4: Photograph of blackish brown wooden foreign body and eyeball after removal
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| Figure 5: Clinical photograph of patient taken on postoperative day 5 showing good healing of wound
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Discussion | | |
Lifetime prevalence of sustaining any type of ocular trauma approaches 19.8%. [4] Eye injury covers a broad range of severity, from small corneal abrasion to the more severe penetrating and globe rupture injuries. Ocular trauma can be described as penetrating or perforating. In a penetrating injury, only one surface of an ocular structure is damaged (i.e., an entrance wound without an exit wound). Perforating injuries are defined as "double penetrating" injuries, creating both entry and exit wounds. [5]
The orbit is shaped like a cone; hence, penetrating objects are directed toward the apex and usually pass through the superior orbital fissure and optic canal to enter the intracranial space. [5],[6] In our case, the foreign body was extending from obit through its apex into cranial cavity, and there was a transaction of the optic nerve at optic canal. Complications range from traumatic cranial neuropathies to potentially fatal intracranial injuries. [7] Ocular complications include optic nerve damage with resultant visual loss, extra-ocular muscle paralysis secondary to direct muscle trauma or nerve damage, proptosis or macular edema. [8] Wooden foreign bodies require early removal and broad spectrum antibiotic coverage to reduce infective complications.
Coronal sections of CT orbit are best suited to understand the exact nature and extent of orbital soft tissue injury. Most blowout fractures involve the floor and medial wall of orbit. [9] Prolapse of the globe out of bony orbit is an extreme situation. There are few prior reported cases in the literature. [1],[2],[3],[4],[5]
We hereby add one more case to literature of posttraumatic fracture of the floor of the orbit and herniation of the eyeball into the maxillary sinus.
Vision is one of the most valued sensations. Binocular vision plays an important role in the quality of life and personal safety. The goal of such surgery should be focused on preservation of vision. Unfortunately, in our case, the patient had a complete transaction of the optic nerve; hence, vision could not be preserved.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/ their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References | | |
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8. | Laraque D; American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Injury risk of nonpowder guns. Pediatrics 2004;114:1357-61. |
9. | Raghav B, Vashisht S, Keshav BR, Berry M. The missing eyeball - CT evaluation (a case report). Indian J Ophthalmol 1991;39:188-9. [ PUBMED] |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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