Beyond the fracture: documenting a unique case of total globe dislocation in orbital trauma

A 62-year-old woman presented to the emergency department following blunt trauma to the right orbital region caused by an impact from a cow horn. Ophthalmologic examination revealed the absence of the globe and no light perception. Computed tomography scans showed dislocation of the globe into the maxillary sinus and fracture of the upper orbital wall. A multidisciplinary surgical approach was used, during which the globe was manually repositioned into the orbit and the lower orbital wall was repaired with polyethylene mesh. Postoperative examination on the first postoperative day showed signs of early stage ocular ischemic syndrome. On long-term follow-up, ptosis and enophthalmos were observed and the absence of light perception, which was thought to be due to optic nerve damage, persisted. Anterior segment examination revealed cataract formation and diffuse iris atrophy. Eye movements were severely restricted in inferior and lateral gaze and esotropia was observed in primary position. This case highlights the rarity of severe globe dislocation as a complication and emphasizes the critical importance of early surgical intervention as timely diagnosis and immediate repositioning are essential for visual recovery in the absence of optic nerve damage.