An Unusual Case of Spontaneous Globe Luxation and Exophthalmos Without Overt Cause
Author: Aleza Andron
Base Hospital / Institution: Shaare Zedek Medical Center
ePoster presentation
Abstract ID: 25-270
Purpose
Globe luxation is a rare and potentially distressing phenomenon. It can be spontaneous or due to trauma. There are a number of factors which are associated with spontaneous globe luxation including: thyroid eye disease (TED), floppy eyelids and shallow
Methods
A retrospective case report
Results
A 77-year-old female, presented to the ER with progressive painless proptosis of her right eye and binocular diplopia for a two-day duration. On exam, there was spontaneous luxation of the right globe (Figure 1); gentle digital pressure was applied to return the globe. Relevant medical history includes hypothyroidism and polymyalgia rheumatica and she has been taking 10 mg of prednisone for many years. On examination, optic nerve functions are preserved. Cover tests demonstrate a large alternate exotropia and left hypertropia. Eye movements are full without any pain. Right eye proptosis with slight eyelid retraction and slight lid lag was inspected. No resistance to retropulsion is noted. Conjunctivas are quiet and corneas are clear. A neurologic exam was normal. Thyroid stimulating hormone (TSH), free T3 and free T4 were all within normal limits. Computed tomography and magnetic resonance imaging scans revealed long orbits with significant fat expansion, stretched extraocular muscles and optic nerve, without enlargement. Bilateral exophthalmos (more severe on the right eye), similar to a previous scan from two years ago, was seen. No orbital space occupying lesion or fat stranding was seen (Figure 2). The patient was discharged after a temporary tarsorrhaphy for further ambulatory evaluation before definitive treatment is considered. Upon follow up, MRI was normal as was TSI. The patient improved clinically. After discussing different options, the patient opted for a permanent tarsorrhaphy.
Conclusion
This is a rare presentation of an older patient presenting with spontaneous globe luxation in the absence of TED. Long-term steroid use may be a cause of severe orbital fat proliferation, which when combined with floppy eyelids can lead to this rare occurrence at this age.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Elena | Drabkin | Shaare Zedek Medical Center |
| Daniel | Rappaport | Shaare Zedek Medical Center |
| Gil | Neuman | Shaare Zedek Medical Center |
