The most common symptoms of traumatic enucleation in patients are sudden loss of vision, extreme pain, edema, and bleeding from the afflicted eye. Ocular aches and headaches are other typical symptoms that can occur(7)(9). In traumatic enucleation the mechanism of optic nerve avulsion is not completely understood however several theories have been postulated, such as direct trauma to the globe, shearing forces resulting from extreme rotation of the globe, a sudden massive increase in intraocular pressure resulting in rupture of lamina cribrosa and expulsion of the globe, sudden forward displacement of the globe, and focal or diffuse vasospasm in the optic nerve(10)(11). Since this injury occurred in a Motor Traffic accident in our index case, it is likely to involve combinations of mechanisms.
Depending on the injury's severity and the patient's general health, traumatic enucleation is managed in a variety of ways. This case was managed as an emergency because of the associated pain and bleeding. Enucleation is frequently required in situations where the eyeball has been severed from the surrounding vital tissue such as the blood and nerve supply hence saving the eye is not possible just as it occurred in this case. The injury sustained by the index case was so severe that enucleation was not unavoidable. Having the knowledge that the patient may experience psychological anguish in addition to his physical symptoms which can lower his quality of life he re-presented after six weeks for the prosthetic eye to minimize the stigma of going around with an anophthalmic socket.
The severity of the injury and the patient's general condition are factors that affect the prognosis for patients with traumatic enucleation. However, with adequate management, patients who have enucleation can often anticipate a favorable functional and cosmetic outcome(10). Patients may also develop psychological conditions such as depression, stigma, anxiety, social isolation, and post-traumatic stress disorder and if these are not resolved in good time it can lead to suicidal ideation and eventual suicide(12). Our patient was almost developing depression until he received the prosthetic eye after six weeks which significantly helped him to regain his self-confidence. Patients may receive a prosthetic eye after enucleation to help them look normal cosmetically again. Artificial eye implants are a successful option for individuals who have suffered traumatic enucleation. The use of these implants can improve the quality of life for patients by increasing their self-esteem and satisfaction with their appearance(12)(13). Orbital Infection, hemorrhage, and scarring are possible complications of enucleation(10) however the use of these implants will minimize their effects.
Our patient sustained this injury in a motor vehicular accident because he was not using his safety seatbelt as other passengers in the vehicle did not sustain any injury during the accident. The use of safety seat belts and child restraints in cars has been noted as one of the important ways of reducing injuries sustained in a motor accident hence compliance with its use should be encouraged(14)(15).