Traumatic Dislocation Of The Globe Into Maxillary Sinus In Orbital Floor Fracture

1. Niska Alfisyahrin
2. Ira Sudarmadji
3. Hernawita Suharko

Department of Ophthalmology, Faculty of Medicine University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Purpose: To report a case of orbital floor fracture with dislocation of the globe into maxillary sinus and the management

Methods: A 23-year old male complained of suddenly blurred vision on the left eye since a week ago after he fell from a tree and his face hit the tree trunk. Visual acuity of the left eye was no light perception. Ophthalmological examination showed there was no globe in the left orbit. CT Scan examination revealed that the globe had dislocated into the maxillary sinus, and large fractures of inferior walls of the orbit were noted. The globe had been impacted within the maxillary sinus without definite rupture. We assessed enophthalmia and orbital floor fracture of the left eye. The patient underwent orbital exploration via infraciliary and transconjunctival approach with silicone block implant under general anesthesia.

Results: The globe has been positioned back into the orbit but with enophthalmic condition due to large fractures that cannot completely repositioned. The visual acuity was no light perception. In patient with orbital floor fractures, vision loss can result from injury to the optic nerve such as traumatic optic neuropathy. Eventhough the procedure is not for visual rehabilitation but it brings better cosmesis for the patient.

Conclusions: Management of this rare case is quite complicated. Generally, the globe can be successfully repositioned to the orbit, but enophthalmic and visual loss may result. It is important to determine the timing of surgery in order to prevent or reduce complication which could happen such as visual loss.