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 Table of Contents  
PHOTO ESSAY
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 599-600

Complete traumatic auto-enucleation of eyeball following road traffic accident


Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India

Date of Submission08-Aug-2021
Date of Acceptance25-Oct-2021
Date of Web Publication13-Apr-2022

Correspondence Address:
Bhawesh C Saha
Department of Ophthalmology, All India Institute of Medical Sciences, Patna - 801 507, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2095_21

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  Abstract 


Keywords: Auto-enucleation, road traffic accident, trauma


How to cite this article:
Sinha P, Saha BC, Awasthi P, Aftab N, Kumar R. Complete traumatic auto-enucleation of eyeball following road traffic accident. Indian J Ophthalmol Case Rep 2022;2:599-600

How to cite this URL:
Sinha P, Saha BC, Awasthi P, Aftab N, Kumar R. Complete traumatic auto-enucleation of eyeball following road traffic accident. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 18];2:599-600. Available from: https://www.ijoreports.in/text.asp?2022/2/2/599/342926



Traumatic enucleation is a rare entity, with road traffic accidents being one of the culprits.

A 26-year-old male presented to the emergency after 24 h following a road traffic accident, with extrusion of the left eyeball out of the socket. He fell on a metallic rod on the sidewalk after collision with a truck while riding a motorcycle, sustaining a full-thickness laceration over his left brow area and a partial thickness laceration over the left cheek area. No other injuries were sustained. He was conscious and oriented but denied perception of light in the left eye, which was seen lying over the laceration in the brow region. A marginal lid laceration was present on the medial part of the lid and a depressed fracture of the left supraorbital region along with crepitus was felt on palpation [Figure 1]. The right eye examination was unremarkable. An urgent contrast-enhanced computed tomography with 3D reconstruction of brain and orbit showed multiple comminuted fracture of the left orbital walls [Figure 2]. On surgical exploration, the auto-enucleated eyeball was found hanging with attachments of inferior palpebral conjunctiva and Tenon's capsule. All the extraocular muscles along with optic nerve (stump length: 2.5 cm) were severed. As the muscles and nerve were already severed and globe hypotonus due to delayed presentation, attempt to reposition the eyeball into the socket was not done and the wounds were sutured to secure hemostasis [Figure 3]. Primary implant was not placed due to extensive inflammation and loss of proper muscle cone. Patient was kept on intravenous antibiotics and analgesics. Postoperatively, visual field of right eye was done, which was normal.
Figure 1: (a) Front view of the patient showing bone deep laceration over left brow (black arrow) with overlying globe and partial thickness laceration over cheek area (white arrow). (b) Side view. (c) Globe attached to the socket via remaining palpebral conjunctiva and Tenon's capsule (blue arrow). (d) Optic nerve stump seen hanging out (black arrow)

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Figure 2: (a) Axial view of CECT face showing remaining stump of left optic nerve with thickened nerve sheath (red arrow) and thickened lateral rectus. (b) Coronal view of CECT face showing intact frontal sinuses and comminuted fracture of left frontal bone (red arrow), and intact lamina papyracea. (c) 3D reconstruction showing comminuted fracture of frontal process of left zygomatic bone (red arrow), zygomatic process of frontal bone, supraorbital ridge, and fracture of left nasal bone

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Figure 3: (a) Sutured laceration of left brow area. (b) Closed conjunctiva and tenon's capsule without primary implant

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  Discussion Top


Most of the cases of auto-enucleation reported in the literature were a result of some psychotic illness or drug abuse leading to self-mutilation or physical assault/gauging.[1],[2] Literature review also suggests people having gauged eyes during acts of extreme sexual violence.[3] Road traffic accidents have not been very commonly seen to cause auto-enucleations, but there are a few case reports of traumatic enucleation in the literature.[4],[5] Management comprises preservation of globe whenever possible, which is very challenging in such cases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shiwach RS. Autoenucleation--a culture-specific phenomenon: A case series and review. Compr Psychiatry 1998;39:318-22.  Back to cited text no. 1
    
2.
Fan AH. Autoenucleation: A case report and literature review. Psychiatry (Edgmont) 2007;4:60-2.  Back to cited text no. 2
    
3.
Bukhanovsky AO, Hempel A, Ahmed W, Meloy JR, Brantley AC, Cuneo D, et al. Assaultive eye injury and enucleation. J Am Acad Psychiatry Law 1999;27:590-602.  Back to cited text no. 3
    
4.
Paul S, Lucarelli MJ, Griepentrog GJ. Traumatic enucleation with chiasmal damage. Ophthalmology 2017;124:767.  Back to cited text no. 4
    
5.
Zhou SW, Pang AYC, Poh EWT, Chin CF. Traumatic globe luxation with chiasmal avulsion. J Neuroophthalmol 2019;39:41-3.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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