Traumatic evulsion of the globe

Purpose: To report the clinical and pathologic findings in 3 cases of traumatic evulsion of the globe, during which the optic nerve and its sheath were disrupted at different locations and to varying extents. Methods: Case series (3 patients). Results: We describe the clinical, gross, and microscopic pathologic findings in 3 globes that were traumatically evulsed from their orbits. The optic nerves and sheaths were disrupted at 2 different locations and in 2 distinct combinations. Two of these variations in discontinuity of the nerve and/or its sheath were unique. In 1 case, the eye and optic nerve sheath were evulsed without the nerve; in another case, the nerve and sheath were pulled from the posterior sclera at the lamina cribrosa. Conclusions: Traumatic evulsion of the globe may cause the optic nerve and its sheath to be disrupted at varying distances from the eye and may involve the optic nerve and its sheath together or separately. To the best of our knowledge, no cases have been reported in which orbital trauma caused the globe and optic nerve sheath to be removed together, leaving the nerve behind, or in which disruption of the optic nerve at the lamina cribrosa resulted in a complete posterior scleral defect. Three theories are proposed to explain possible mechanisms leading to optic nerve disruption during traumatic evulsion of the globe.