Journal List > J Korean Ophthalmol Soc > v.49(2) > 1008198

Lee, Ahn, Kyung, and Chang: A Case of Dislocation of the Globe into the Maxillary Sinus after Orbital Wall Fracture

Abstract

Purpose

We report a case of a 38-year-old man who suffered a blowout fracture of the orbital wall with an intact eyeball entrapped within the maxillary sinus after trauma.

Case summary

The 38-year-old man was admitted to the emergency room after sustaining a work-related trauma. His chief complaints were loss of vision and bleeding from the left periorbital area. He had no light perception and no eyeball was found in the orbit. Facial CT revealed that the intact eyeball was entrapped within the maxillary sinus. The condition of the optic nerve was difficult to ascertain. Ten hours after post-trauma, reduction surgery was done with a graft from the iliac bone. Ruptured extraocular muscles were not primarily sutured. After four months, vitrectomy was performed on the left eye. The eyeball was repositioned in its place. He had no light perception. Extraocular motility improved at the last follow-up examination.

Conclusions

We report the dislocation of the eyeball globe into the maxillary sinus after a blowout fracture. Visual acuity showed no light perception as a result of central retinal artery occlusion and optic nerve injury. We were able to obtain a good aesthetic and functional result after the operation.

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Figure 1.
The photograph shows conjunctival edema and no eyeball in the left orbit.
jkos-49-368f1.tif
Figure 2.
(A) Preoperative coronal CT scan shows fracture of the left inferior and medial orbital wall and herniated eyeball (arrow) in the maxillary sinus. Large amount of hemorrhage was found within the ethmoid and maxillary sinuses. (B) Preoperative sagittal CT scan shows herniated eyeball(arrow) in the maxillary sinus.
jkos-49-368f2.tif
Figure 3.
The patient had severe limitation of extraocular movement in all direction.
jkos-49-368f3.tif
Figure 4.
(A) Postoperative CT shows the left globe within the orbit and part of the iliac bone. (B) Axial section of the left orbit shows normal location of the left globe.
jkos-49-368f4.tif
Figure 5.
F-VEP shows delayed latency and decreased amplitude in the left eye.
jkos-49-368f5.tif
Figure 6.
ERG of the left eye shows no response.
jkos-49-368f6.tif
Figure 7.
After 1 month of vitrectomy, eyeball movement shows improvement.
jkos-49-368f7.tif
Figure 8.
Fundus examination shows extreme narrowing of the retinal vessels and pale optic disc one month after vitrectomy. In contrast to normal choroidal filling, there was delayed arterial filling at 18 seconds after fluorescein dye injection.
jkos-49-368f8.tif
Figure 9.
Multifocal ERG of the left eye shows decreased amplitude.
jkos-49-368f9.tif
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