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A 56-YEAR-OLD man complained of his left eye "popping out" 3 times during the past 2 months while asleep. This caused him to awaken; however, the globe would return to its normal position spontaneously. The patient slept mostly on his left side. He denied ocular pain, decreased vision, or a notable medical history.
Ophthalmic examination showed a visual acuity of 20/25 OU. Extraocular movements, pupils, intraocular pressures, slitlamp, and funduscopic examination findings showed no abnormalities. Hertel measurements were 18-in in both eyes. There was no facial asymmetry (Figure 1 and Figure 2), but marked floppy eyelids with papillary changes were noted (Figure 3). While retracting the eyelid superotemporally, the globe luxated spontaneously (Figure 4 and Figure 5). This was the same phenomenon the patient noticed on previous occasions. Orbital echographic scan revealed normal extraocular muscles. A computed tomographic scan of the orbits showed shallow orbital sockets (Figure 6). Thyroid function test results showed no abnormalities. The patient was instructed to try sleeping supine, using a shield or goggles, or taping the eyelids shut at night. Four months later, he had 1 brief episode of globe luxation. He refused surgical treatment.
A 56-year-old man in primary gaze. There is no eyelid retraction.
The left lateral view demonstrates no proptosis.
Patient was noted to have profound eyelid laxity and conjunctival injection with a papillary reaction on the upper tarsal conjunctiva.
Prominent luxation of the left globe that was easily induced on elevating the floppy left upper eyelid.
Left lateral view demonstrates spontaneous globe luxation.
An axial computed tomographic scan of the orbits shows normal extraocular muscle size and shallow sockets. The globe equators lie anterior to the lateral walls.
We believe that the spontaneous globe luxation in this patient was caused by the combined mechanism of shallow orbital sockets, an anteriorly situated globe, and floppy eyelids1 that migrate behind the globe when this phenomenon occurs. This patient did not have axial exophthalmos, and the result of the workup for thyroid eye disease was negative. Surgical treatment options for this condition include partial lateral tarsorrhaphy, pentagonal wedge eyelid resection, or advancement of the lateral orbital wall.2 - 3 To our knowledge, this is the first reported case of spontaneous globe luxation associated with floppy eyelids and shallow orbits.
Corresponding author: David T. Tse, MD, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136 (e-mail: dtse@bpei.med.miami.edu).
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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