Journal: Anesth Analg 107(5):1630-1631, 2008.
Reprint: Mayo Clinic, JAB 4035, 4500 San Pablo Rd, Jacksonville, FL 32224 (SR Clendenen, MD)
Faculty Disclosure: Abstracted by R. Ouellette, who has nothing to disclose.
Ocular globe luxation is uncommon in the general population, and has never been reported in the anesthesia literature. Luxation of the globe can lead to serious complications, such as traction on the optic nerve with subsequent nerve injury, or venous con-gestion with potential damage to the retina. This case report describes a 70-year-old man with a history of degenerative disease of his left hip presenting for a left total hip arthroplasty. On physical examination, the patient was obese and had proptotic-appearing eyes. The patient was taken to the operating room and appropriate monitors were applied. After induction and intubation, the eyelids were taped shut. The patient was positioned in the right lateral decubitus position with axillary padding for protecÂtion. He underwent an uneventful left hip arthroplasty with a total anesthetic duration of 180 minutes. Intraoperatively he received 2200 mL of lactated Ringer's solution. His estimated blood loss was 400 mL.
Upon completion of surgery, the patient was placed in the supine position. The right (dependent) eyelid was gently retracted to examine for conjunctival edema, which resulted in immediate globe luxation. The lids spontaneously closed with the eye prolapsed outside the orbit. Immediately upon luxation, the upper lid was retracted, and the globe was gently repositioned into the orbit. The patient was re-examined in the postoperative recover area and reported no pain, discomfort, or decrease in vision. The extraocular movements were intact and symÂmetric. A repeat examination 24 hours later was unchanged, and the patient recovered without other complications.
Although uncommon, globe luxation can occur after uneventful anesthesia. Risk factors for globe luxation include African American race, proptosis, shallow orbits, and floppy eyelid syndrome, which can occur with obesity. The most common cause of proptosis in adults is Graves' disease. If proptosis is identified preoperatively, patients should be asked if they have a history of luxation. If globe luxation does occur, the first priority is to reposition the globe to its original position. Typically, gentle retraction of the eyelids and gentle pressure applied to the globe will allow the eye to be repositioned without difficulty. |
