View source for Globe luxation reduction

==Background==
*Extreme [[proptosis]] which permits lids to slip behind globe equator, obicularis oculi spasm sustains luxation
*Can be traumatic, spontaneous or voluntary
**In spontaneous globe luxation, extraocular muscles and optic nerve generally remain intact.<ref>Tok L, Tok OY, Argun TC, et al. Bilateral Traumatic Globe Luxation with Optic Nerve Transection. Case Reports in Ophthalmology. 2014;5(3):429-434. doi:10.1159/000370043.</ref>
**In traumatic globe luxation, optic nerve avulsion is common (occurs in 38.2%)<ref>Amaral MB, Carvalho MF, Ferreira AB, Mesquita RA. Traumatic globe luxation associated with orbital fracture in a child: a case report and literature review. J Maxillofac Oral Surg. 2015 Mar;14(Suppl 1):323-30.</ref>
*Early reduction indicated to relieve symptoms and minimize visual impairment

==Indications==
*Spontaneous or traumatic globe luxation

==Contraindications==
*[[Globe rupture]] (relative)

==Procedure==
*Perform rapid eye exam including visual acuity
*If traumatic, consider imaging to rule out orbital deformity, retrobulbar hemorrhage, etc
*Place patient in recumbent position
*Apply topical ocular anesthetic (e.g. tetracaine)
*When lashes are visible, have asst apply steady upward and outward traction to lids.  If unable to grasp lashes, use lid retractor to apply countertraction
*With gloved fingers, gently apply scleral pressure and manipulate back into orbit
*Assess for and remove retained lashes to prevent corneal injury
*Repeat eye exam (acuity may not improve for days or longer)

==Complications==
*Retained lashes
*Failure to reduce (apply saline drops and non-contact eye shield)

==Follow-Up==
*Traumatic luxation requires emergent ophthalmology consult
*Spontaneous luxation (s/p reduction) with no visual impairment → follow up in 24-48 hours, avoid triggering maneuvers

==References==
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[[Category:Ophthalmology]] 
[[Category:Procedures]]