You can relax associated blepharospasm by injecting lidocaine into the facial nervea maneuver you should reserve for only intractable cases.Īfter repositioning the globe, search for possible causes of subluxation. If this doesnt work, apply pressure to the anesthetized globe medially and laterally to the cornea using a traditional contact lens remover. Use artificial tears along with a topical anesthetic to rehydrate those tissues and make the patient more comfortable. When an eye subluxates, the lids no longer spread tears from the lacrimal lake across the cornea and conjunctival tissues, so the globe can quickly dry out. Overreacting with excessive force may produce damage to ocular structures and/or the optic nerve. Second, with the slightest encouragement, subluxation can be reduced. First, its not necessary the globe naturally wants to move back to where it belongs. As you do this, gently push the globe back into place.ĭont push too hard, Dr. Andrew Archila, O.D., of Sigonella, Italy, recommends using a cotton swab to roll the lids back. Next, as the patient looks up at the ceiling, use your fingers to spread the patients lids around the front of the globe.

Then, instruct the patient not to squeeze the subluxated eye (this will only push the eye out further), and not to squint the uninvolved eye. Sometimes the force of gravity is enough to allow the globe to slip back into the socket. Patient relaxation is key in order to allow the orbicularis oculi muscle to relax and to make globe manipulation easier, adds Bruce Muchnick, O.D., also a professor at Pennsylvania College of Optom-etry. These patients will be alarmed, frightened and in a lot of pain, says Andrew Gurwood, O.D., associate professor at the Eye Institute of the Pennsyl-vania College of Optometry in Philadelphia. First, be sure the patient is comfortable and calm. What should I have done in this situation?Ī This is called globe subluxation and is actually becoming more common as ever more patients wear contact lenses. I rushed over to see that the patients left eye prolapsed out onto her cheek.

Q A staff member was instructing a female patient on insertion and removal of her contact lenses, when I heard a scream from the adjacent room.

Eye out of socket