A Simple Maneuver to Reposit a Subluxed Globe

In patients with thyroid orbitopathy, severe lid retraction and proptosis may produce spontaneous axial globe subluxation. This acute event is characterized by anterior displacement of the globe beyond the orbital rim, retraction of both upper and lower eyelids behind the globe, and tethering of the optic nerve. This frightening occurrence causes severe pain because of exposure keratopathy and forward displacement of the globe, as the retracted eyelids are squeezing the retrobulbar tissues. Spontaneous globe subluxation frequently occurs at home or at work, and patients experiencing this for the first time often panic because they have never been forewarned of this possibility nor received any instruction on how to attend to such an emergency. The lack of concise patient instruction for a quick and safe method of self-administered globe reposition is the main impetus for the design of current technique.