[Management of unilateral traumatic bulb luxation with disruption of the optic nerve]

Luxation of the eyeball, which means that the eye protrudes between the eyelids,may occur spontaneously or as a rare sequel to major trauma to the orbital wall. It can be accompanied by a disruption of the optic nerve, which is called optic nerve avulsion. In most cases primary enucleation is performed as therapeutic treatment. In our case of a 1 1/2-year-old child bulb luxation with disruption of the optic nerve followed a relatively slight trauma,presumably a fall onto a toy. An irreversible amaurosis was diagnosed. To guarantee symmetrical growth of the orbita and face, the eyeball was replaced into the orbit under microscopic and endoscopic vision via a transnasal and transethmoidal approach.Postoperative examinations showed an exotropy with unrestricted motility of the globe and amaurosis. Five years after the trauma we found symmetrical facial development with uniform orbital cavities. The clinical features and management of globe luxation are discussed, importance of a rapid reposition of the eyeball in contrast to primary enucleation for functional, cosmetic and psychological reasons is emphasized.