Traumatic prolapse of the globe into the anterior cranial fossa: a case report

Abstract

Background: Orbital fracture associated with traumatic intracranial prolapse of the eyeball is rare. In all previously reported cases, vision was severely impaired with no light perception. Herein, we report a case of traumatic prolapse of the globe into the anterior cranial fossa, in which the patient's vision was preserved by early repositioning. Case presentation: The present case report focused on a man hit by a steel pipe, leading to prolapse of the globe of the right eye into the anterior cranial fossa through fractures in the superior orbit roof, accompanied by cerebral contusion. The eyeball was immediately repositioned into the orbital cavity, along which the wound tract was debrided and the skull base was repaired. The patient underwent a follow-up period of 12 months, during which the visual acuity increased to 12/20 without any intracranial infections. However, the patient's ptosis persisted and was associated with complete loss of supraduction. Conclusions: In this case, early diagnosis and proper globe repositioning with reconstruction of the orbital roof could allow recovery of vision, as well as prevention of intracranial infection.

Traumatic Dislocation of the Globe into the Ethmoid Sinus

“… 2 Even less common is dislocation into the frontal sinus 6 and the anterior cranial fossa behind the orbit. 7 No cases of globe dislocation into the sphenoid sinus have been reported. With traffic accidents and blunt trauma, the globe is often dislocated intact through a wide fracture line in the medial and inferior walls of the orbit.…”

Traumatic dislocation of the eye into the maxillary sinus: Case report and literature review

“…We examined case reports of traumatic eye dislocation in adults published between 1981 and 2020, following a detailed investigation of English-language literature across PubMed (Table S1). In total, there were 19 cases: 16 men and 3 women aged 17-68 years [2,6,[8][9][10][11][12][13][14][15][16][17][18]20,21,30,31]. Traffic accidents predominated among the injury mechanisms, while only in two cases it was due to assault [8,12].…”

“…Traffic accidents predominated among the injury mechanisms, while only in two cases it was due to assault [8,12]. In 16 cases, the eye was dislocated into the maxillary sinus [2,6,[8][9][10][11][12][13][14][15][17][18][19]31], and the remaining three were into the ethmoid alveoli, the anterior fossa of the skull, and the brain [20][21][22]. Out of the 19 cases, the optic nerve was not injured in 12 cases [2, [8][9][10][13][14][15][17][18][19][20]22], was partially severed in three cases [6,11,16], and was completely severed in three cases [12,21,31].…”

“…Traumatic eye dislocation can be divided into two types: When the eye is displaced outward from the orbit, and when it is displaced either into the paranasal sinuses (the maxillary, ethmoid, and frontal sinuses) or into the cranial cavity or brain [2–22]. We have repeatedly come across eye dislocation in the past, such as in cases where a pedestrian was hit by a moving train.…”