A 56-YEAR-OLD man complained of his left eye "popping out" 3 times during the past 2 months while asleep. This caused him to awaken; however, the globe would return to its normal position spontaneously. The patient slept mostly on his left side. He denied ocular pain, decreased vision, or a notable medical history.
Ophthalmic examination showed a visual acuity of 20/25 OU. Extraocular movements, pupils, intraocular pressures, slitlamp, and funduscopic examination findings showed no abnormalities. Hertel measurements were 18-in in both eyes. There was no facial asymmetry (Figure 1 and Figure 2), but marked floppy eyelids with papillary changes were noted (Figure 3). While retracting the eyelid superotemporally, the globe luxated spontaneously (Figure 4 and Figure 5). This was the same phenomenon the patient noticed on previous occasions. Orbital echographic scan revealed normal extraocular muscles. A computed tomographic scan of the orbits showed shallow orbital sockets (Figure 6). Thyroid function test results showed no abnormalities. The patient was instructed to try sleeping supine, using a shield or goggles, or taping the eyelids shut at night. Four months later, he had 1 brief episode of globe luxation. He refused surgical treatment.
Alexandrakis G, Tse DT, Chang WJ. Spontaneous Globe Luxation Associated With Floppy Eyelid Syndrome and Shallow Orbits. Arch Ophthalmol. 1999;117(1):138-139. doi:10.1001/archopht.117.1.138