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 Table of Contents    
CLINICAL IMAGE
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 407-408  

Eye gangrene following traumatic enucleation


Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

Date of Submission26-Mar-2021
Date of Decision08-Jun-2021
Date of Acceptance08-Jul-2021
Date of Web Publication02-Nov-2022

Correspondence Address:
Amin Zand
Eye Research Center, Rassoul Akram Hospital, Sattarkhan-Niaiesh St., Tehran 1445613131
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.ojo_100_21

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   Abstract 


Keywords: Eye globe, gangrene, necrosis, traumatic enucleation


How to cite this article:
Zand A. Eye gangrene following traumatic enucleation. Oman J Ophthalmol 2022;15:407-8

How to cite this URL:
Zand A. Eye gangrene following traumatic enucleation. Oman J Ophthalmol [serial online] 2022 [cited 2022 Dec 2];15:407-8. Available from: https://www.ojoonline.org/text.asp?2022/15/3/407/360391



The patient was a 26-year-old female who had suffered an accelerated–decelerated trauma to the head and neck in a car accident the previous day. She had severe left facial soft tissue injury and Le Fort II left maxillofacial fracture. The left globe was protruded and became completely gangrenous outside the orbit. The protruded globe did not have any obvious lacerations [Figure 1]. Her best-corrected visual acuity was 20/25 in the right eye with no light perception in the left. Further examination of the right eye was not remarkable. Orbital computed tomography scans showed traumatic enucleation of the left eye. The globe was intact and completely avulsed from other structures, including the optic nerve, extraocular muscles, ophthalmic vessels, and connective tissues with complete anterior globe protrusion [Figure 2]. After her condition had become stable, the globe and a segment of avulsed optic nerve were removed. She was treated with oral ciprofloxacin and prednisolone 50 mg/day tapered gradually. Traumatic enucleation implies complete avulsion of the eye globe with disruption of the optic nerve and all extraocular muscles following any kind of trauma.[1] I hypothesized that a high-energy trauma resulting fascial bones fractures and severe deceleration led to this situation.
Figure 1: Near-total overhanging of the left globe from the orbit. The globe is gangrenous, without any detectable structures

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Figure 2: Axial orbital computed tomography scan reveals the globe luxation to be completely outside the orbital rim with avulsion of medial and lateral rectus muscles from the globe (red asterisks). In addition, the avulsed optic nerve exhibits misalignment with the globe (white asterisk)

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The term “gangrene” is used to describe the black necrosis of the whole globe tissue due to the lack of any blood supplies after the complete enucleation (defined as dry gangrene). The patient did not have any additional risk factors to accelerate the gangrene process, including immunosuppression, diabetes mellitus, systemic vascular diseases, and globe laceration (a route for entrance of microorganisms to the globe especially of Clostridium perfringens, resulting in gas gangrene infection, defined as wet gangrene).[2],[3]

Reported cases of accidental traumatic enucleation are rare.[4],[5] To my knowledge, accidental traumatic enucleation with the aforementioned manifestations including rapid eye gangrene has not previously been reported.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that her 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.
Saunders T, Slonim C. Traumatic enucleation series. Investig Ophthalmol Vis Sci 2010;51:4882.  Back to cited text no. 1
    
2.
Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N, et al. Fournier's gangrene: Risk factors and strategies for management. World J Surg 2006;30:1750-4.  Back to cited text no. 2
    
3.
Crock GW, Heriot WJ, Janakiraman P, Weiner JM. Gas gangrene infection of the eyes and orbits. Br J Ophthalmol 1985;69:143-8.  Back to cited text no. 3
    
4.
Razmjua H, Masjedi M. Traumatic bilateral globe avulsion (case report). J Res Med Sci 2009;14:259-60.  Back to cited text no. 4
    
5.
De Moraes AT, Quaresma MC, Silva TF, Sousa NW, Menezes SA, Ribeiro AL, et al. Traumatic enucleation of the left globe after a road traffic accident - A case report of an uncommon occurrence in maxillofacial trauma. Int J Surg Case Rep 2021;78:133-9.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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