Improving the Care Outcomes of Traumatic Enucleation with Artificial Eye Implant: a case report

Improving the Care Outcomes of Traumatic Enucleation with Artificial Eye Implant: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Improving the Care Outcomes of Traumatic Enucleation with Artificial Eye Implant: a case report Olumide Adeleke, Akinsola Aina, Oluseun Awe, ifeoluwasemilojo Aina This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4618201/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Traumatic enucleation is a rare consequence of high-impact trauma. It is a severe injury leading to permanent loss of vision. One of the most common causes of traumatic globe enucleation is automobile accidents. This damage may have a severe effect on the patient's physical and mental health. Apart from the permanent loss of vision in the affected eye with traumatic enucleation, some complications, including pseudoptosis, orbital infection, hemorrhages, and scarring can occur. Traumatic enucleation may also be complicated by psychological problems like stigma, depression, anxiety, and post-traumatic stress disorder. However, following enucleation, patients might be given a prosthetic eye to help them appear like normal eyes once more and prevent psychological problems. The goal of this case report is to highlight the potential occurrence of traumatic enucleation following a road traffic accident, as well as to describe the appropriate management of patients who present with this condition including the role of artificial eye implants in the management of such patients. traumatic enucleation road traffic accident artificial eyes implant. Figures Figure 1 Figure 2 Figure 3 Introduction Traumatic enucleation is the complete removal of a whole eyeball following trauma. It has an estimated frequency of 12 per 100,000 people between 1956 and 1988 reported in the literature, it is a rather uncommon injury( 1 ). Blunt force trauma such as occurs in assault is the most common cause of traumatic ocular injury that leads to enucleation( 2 )( 3 ). Gunshots, stab wounds, motor vehicle accidents (MVA), task-related (including workplace, and travel), recreation, and falls are possible causes of these injuries( 4 )( 2 ). A 3:1 male-to-female ratio in its incidence indicates that males are more likely affected than females( 4 ). However non-traumatic cases of auto-enucleation had been reported usually in psychiatric or drug-abuse patients( 5 )( 6 ). Traumatic enucleation requires a significant retro-ocular force to cause globe separation from the surrounding supportive structures within the orbit with complete optic nerve avulsion( 7 ). This damage may have a severe effect on the patient's physical and mental health. Traumatic enucleation will result in permanent loss of vision in the affected eye( 7 ) and a number of complications, including pseudoptosis, orbital infection(cellulitis), hemorrhages, and scarring( 8 ). The purpose of this case report is to illustrate traumatic enucleation as a potential consequence following a road traffic accident and to describe the role of artificial eye implants in the management of such patients. Case Report A 35-year-old man presented to the emergency unit in the eye clinic at Bowen University Teaching Hospital Ogbomoso with a 2-hour history of sustaining trauma to the right eye in a road traffic accident. He was a passenger sitting in the front seat (not using a seat belt) of a car trying to overtake a long-articulated truck, in the process, the car collided with the truck from the side and the car somersaulted many times before falling into a ditch from where passersby came to rescue the occupants of the vehicle. There was no loss of consciousness however there was bleeding from the right eye. On presentation at the emergency unit, he was conscious and alert, he had a laceration extending across his right upper and lower eyelid which was already sutured by the causality officer. The entire right eyeball was protruding through the eyelid rotated superior-nasally exposing the avulsed end of the optic nerve inferotemporally (double arrow in the photograph at presentation). The eyeball was just held down by the conjunctiva. He was promptly treated with analgesics and antibiotics in the casualty room. He was immediately informed and counseled about the nature and extent of ocular injury, noting that the optic nerve was avulsed already and the process of enucleation needed to be completed. The patient was initially sad and worried about the visual loss and the cosmetic insult from the incident. However, he was adequately counseled and reassured of a prosthetic eye for aesthetic purposes. His fear was allayed, informed consent was obtained and he was subsequently taken to the operating room where the enucleation was completed by excising the remaining conjunctiva holding the globe. He was subsequently discharged home after 48 hours when the inner pack was removed. An orbital implant with an artificial eye was implanted 6 weeks afterward. The patient was satisfied with the outcome of his care and he was particularly grateful for the ocular implant. Discussion 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 ). Conclusions Traumatic enucleation is an uncommon but severe injury that can have severe negative impacts on both the patient's physical and mental health. With prompt and effective management, impact of the injury sustained can be minimized. Passengers should ensure they use seat belts according to the road safety guidelines globally. A comprehensive approach is necessary for the management of this injury to meet the patient's physical and emotional demands. Future studies should concentrate on enhancing the quality of life of people who have had enucleation with artificial implants to create more efficient treatment modalities for this type of injury. Declarations Conflict of Interest: I declare that there are no conflicts of interest in the conduct of this research work. Consent to Publish: Written informed consent for publication of the patient’s clinical details and clinical images was obtained from the patient. A copy of the consent form is available for review by the Editor of this journal. Funding: There was no funding or financial support received in the conduct of this research work by any of the authors. Author Contribution -O.A wrote the initial draft of the case report.-A.A. reviewed the initial draft and expanded the discussion.- O.Aw. reviewed the entire report with significant input.-I.A. Edited the report with significant input.-All authors reviewed the final manuscript. Acknowledgement I acknowledge the support of staff in the operating room who worked with me while managing this case. References Erie JC, Nevitt MP, Hodge D, Ballard DJ. Incidence of enucleation in a defined population. Am J Ophthalmol [Internet]. 1992 Feb 1 [cited 2024 Jun 12];113(2):138–44. Available from: http://www.ajo.com/article/S0002939414715259/fulltext Elkbuli A, Meneses E, Kinslow K, McKenney M, Boneva D. A rare case of pre-hospital globe enucleation after a penetrating injury to the orbit during an assault: A case report and literature review. Int J Surg Case Rep [Internet]. 2020 Jan 1 [cited 2024 May 31];75:231. Available from: /pmc/articles/PMC7509343/ Shafa S, Zand A, Sharifi A, Sharifzadeh M. Traumatic Globe Enucleation After Blunt Head Injury. Cureus [Internet]. 2022 Apr 25 [cited 2024 Jun 10];14(4). Available from: /pmc/articles/PMC9132745/ Lundin AM, Azari AA, Kanavi MR, Potter HD, Lucarelli MJ, Burkat CN, et al. Ocular trauma resulting in enucleation: A 12-year experience from a large regional institution. Wis Med J [Internet]. 2014;113(3):99–101. Available from: http://www.useironline.org/epidemiology. Fan AH. Autoenucleation: A Case Report and Literature Review. Psychiatry (Edgmont) [Internet]. 2007 Oct [cited 2024 Jun 10];4(10):60. Available from: /pmc/articles/PMC2860527/ Patton N. Self-inflicted eye injuries: a review. Eye [Internet]. 2004 [cited 2024 Jun 10];18:867–72. Available from: www.nature.com/eye de Moraes ATL, Quaresma MCA, Silva TF, Sousa NWA, Menezes SAF, Ribeiro ALR, et al. Traumatic enucleation of the left globe after a road traffic accident – A case report of an uncommon occurrence in maxillofacial trauma. Int J Surg Case Rep [Internet]. 2021 Jan 1 [cited 2024 Jun 8];78:133. Available from: /pmc/articles/PMC7750125/ Valeshabad AK, Naseripour M, Asghari R, Parhizgar SH, Parhizgar SE, Taghvaei M, et al. Enucleation and evisceration: indications, complications and clinicopathological correlations. Int J Ophthalmol [Internet]. 2014 [cited 2024 Jun 10];7(4):677. Available from: /pmc/articles/PMC4137206/ Unal S, Argin A, Arslan E, Demirkan F, Aksoy A. Bilateral Complete Avulsion of Ocular Globes in a Le Fort III Maxillofacial Fracture: A Case Report and Review of the Literature. https://doi.org/101177/112067210501500119 [Internet]. 2005 Jan 1 [cited 2024 Jun 10];15(1):123–5. Available from: https://journals.sagepub.com/doi/10.1177/112067210501500119?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed Gurram P, Ramakrishnan K, Vivek N, Chandran S, Parthasarathy P, Kumar DS. Complete Globe Avulsion in a 13-Year-Old Young Boy with Maxillofacial Injury: A Case Report and Review of Literature. https://doi.org/101055/s-0038-1667068 [Internet]. 2018 Jan 1 [cited 2024 Jun 12];2(1):s-0038-1667068. Available from: https://journals.sagepub.com/doi/10.1055/s-0038-1667068?icid=int.sj-full-text.similar-articles.8 Sanborn G, Gonder J, … RG-C journal of, 1984 undefined. Evulsion of the optic nerve: a clinicopathological study. Eur Sanborn, JR Gonder, RE Goldberg, WE Benson, S KesslerCanadian J Ophthalmol J Can d’ophtalmologie, 1984•europepmc.org [Internet]. [cited 2024 Jun 12]; Available from: https://europepmc.org/article/med/6713263 Keys J, Dempster M, Jackson J, Williams M, Coyle S. The psychosocial impact of losing an eye through traumatic injury and living with prosthetic restoration: A thematic analysis. Acta Psychol (Amst). 2021 Sep 1;219:103383. Pine K. The Impact of Eye Loss and Prosthetic Eye Wear on Recreational, Occupational and Social Areas of Functioning. J Ophthalmol Vis Sci [Internet]. 2017 [cited 2024 Jun 12];2(1). Available from: www.austinpublishinggroup.com Bachani AM, Peden M, Gururaj G, Norton R, Hyder AA. Road Traffic Injuries. Dis Control Priorities, Third Ed (Volume 7) Inj Prev Environ Heal [Internet]. 2017 Oct 27 [cited 2024 Jun 12];35–54. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525212/ States JD. The prevention of injury secondary to motor vehicle accidents. Clin Orthop Relat Res. 1987;222:21–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4618201","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":330832164,"identity":"8d362491-a2fe-49f9-95cf-d8d2baa54a41","order_by":0,"name":"Olumide Adeleke","email":"","orcid":"","institution":"Bowen University","correspondingAuthor":false,"prefix":"","firstName":"Olumide","middleName":"","lastName":"Adeleke","suffix":""},{"id":330832165,"identity":"b239e9a0-2dc3-411c-93ef-ee1da14038c3","order_by":1,"name":"Akinsola Aina","email":"data:image/png;base64,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","orcid":"","institution":"Bowen University","correspondingAuthor":true,"prefix":"","firstName":"Akinsola","middleName":"","lastName":"Aina","suffix":""},{"id":330832166,"identity":"41b900ba-2172-4071-8bc6-970698bee444","order_by":2,"name":"Oluseun Awe","email":"","orcid":"","institution":"Bowen University","correspondingAuthor":false,"prefix":"","firstName":"Oluseun","middleName":"","lastName":"Awe","suffix":""},{"id":330832167,"identity":"555e2294-613a-433c-a5e2-ff3ce5f369f9","order_by":3,"name":"ifeoluwasemilojo Aina","email":"","orcid":"","institution":"Bowen University","correspondingAuthor":false,"prefix":"","firstName":"ifeoluwasemilojo","middleName":"","lastName":"Aina","suffix":""}],"badges":[],"createdAt":"2024-06-21 16:15:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4618201/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4618201/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61525393,"identity":"ce30266b-0546-44a3-809a-071b78d6c1f2","added_by":"auto","created_at":"2024-07-31 19:49:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":949327,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAt presentation: Avulsed optic nerve (arrowed) of the auto-enucleated globe\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4618201/v1/4adb3ce080fd1d6ba9286885.png"},{"id":61525633,"identity":"60ed3345-873b-4b0b-96e3-d21365ef2555","added_by":"auto","created_at":"2024-07-31 19:57:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2475914,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSix weeks post- op.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4618201/v1/a8b18dd39c48f02382e571d9.png"},{"id":61525392,"identity":"9dc60bca-3a54-45d1-880e-a12bbeed35c2","added_by":"auto","created_at":"2024-07-31 19:49:14","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2198817,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSix weeks post-op with artificial eye implant\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4618201/v1/a9088a54d1e80548bfdee855.png"},{"id":63772580,"identity":"5abe418c-90c8-4d5b-b318-ba5c93b059b7","added_by":"auto","created_at":"2024-09-02 08:23:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8521936,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4618201/v1/a2f0080e-d358-4e7e-bec4-4da96169c263.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improving the Care Outcomes of Traumatic Enucleation with Artificial Eye Implant: a case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTraumatic enucleation is the complete removal of a whole eyeball following trauma. It has an estimated frequency of 12 per 100,000 people between 1956 and 1988 reported in the literature, it is a rather uncommon injury(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Blunt force trauma such as occurs in assault is the most common cause of traumatic ocular injury that leads to enucleation(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Gunshots, stab wounds, motor vehicle accidents (MVA), task-related (including workplace, and travel), recreation, and falls are possible causes of these injuries(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). A 3:1 male-to-female ratio in its incidence indicates that males are more likely affected than females(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). However non-traumatic cases of auto-enucleation had been reported usually in psychiatric or drug-abuse patients(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Traumatic enucleation requires a significant retro-ocular force to cause globe separation from the surrounding supportive structures within the orbit with complete optic nerve avulsion(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This damage may have a severe effect on the patient's physical and mental health. Traumatic enucleation will result in permanent loss of vision in the affected eye(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and a number of complications, including pseudoptosis, orbital infection(cellulitis), hemorrhages, and scarring(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The purpose of this case report is to illustrate traumatic enucleation as a potential consequence following a road traffic accident and to describe the role of artificial eye implants in the management of such patients.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 35-year-old man presented to the emergency unit in the eye clinic at Bowen University Teaching Hospital Ogbomoso with a 2-hour history of sustaining trauma to the right eye in a road traffic accident. He was a passenger sitting in the front seat (not using a seat belt) of a car trying to overtake a long-articulated truck, in the process, the car collided with the truck from the side and the car somersaulted many times before falling into a ditch from where passersby came to rescue the occupants of the vehicle. There was no loss of consciousness however there was bleeding from the right eye. On presentation at the emergency unit, he was conscious and alert, he had a laceration extending across his right upper and lower eyelid which was already sutured by the causality officer. The entire right eyeball was protruding through the eyelid rotated superior-nasally exposing the avulsed end of the optic nerve inferotemporally (double arrow in the photograph at presentation). The eyeball was just held down by the conjunctiva. He was promptly treated with analgesics and antibiotics in the casualty room. He was immediately informed and counseled about the nature and extent of ocular injury, noting that the optic nerve was avulsed already and the process of enucleation needed to be completed. The patient was initially sad and worried about the visual loss and the cosmetic insult from the incident. However, he was adequately counseled and reassured of a prosthetic eye for aesthetic purposes. His fear was allayed, informed consent was obtained and he was subsequently taken to the operating room where the enucleation was completed by excising the remaining conjunctiva holding the globe. He was subsequently discharged home after 48 hours when the inner pack was removed. An orbital implant with an artificial eye was implanted 6 weeks afterward. The patient was satisfied with the outcome of his care and he was particularly grateful for the ocular implant.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe 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(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). 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(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Since this injury occurred in a Motor Traffic accident in our index case, it is likely to involve combinations of mechanisms.\u003c/p\u003e \u003cp\u003eDepending 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.\u003c/p\u003e \u003cp\u003eThe 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(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). 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(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). 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(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Orbital Infection, hemorrhage, and scarring are possible complications of enucleation(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) however the use of these implants will minimize their effects.\u003c/p\u003e \u003cp\u003eOur 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(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTraumatic enucleation is an uncommon but severe injury that can have severe negative impacts on both the patient's physical and mental health. With prompt and effective management, impact of the injury sustained can be minimized. Passengers should ensure they use seat belts according to the road safety guidelines globally. A comprehensive approach is necessary for the management of this injury to meet the patient's physical and emotional demands. Future studies should concentrate on enhancing the quality of life of people who have had enucleation with artificial implants to create more efficient treatment modalities for this type of injury.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of Interest:\u003c/h2\u003e \u003cp\u003eI declare that there are no conflicts of interest in the conduct of this research work.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConsent to Publish:\u003c/h2\u003e \u003cp\u003e Written informed consent for publication of the patient\u0026rsquo;s clinical details and clinical images was obtained from the patient. A copy of the consent form is available for review by the Editor of this journal.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThere was no funding or financial support received in the conduct of this research work by any of the authors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e-O.A wrote the initial draft of the case report.-A.A. reviewed the initial draft and expanded the discussion.- O.Aw. reviewed the entire report with significant input.-I.A. Edited the report with significant input.-All authors reviewed the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eI acknowledge the support of staff in the operating room who worked with me while managing this case.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eErie JC, Nevitt MP, Hodge D, Ballard DJ. Incidence of enucleation in a defined population. Am J Ophthalmol [Internet]. 1992 Feb 1 [cited 2024 Jun 12];113(2):138\u0026ndash;44. Available from: http://www.ajo.com/article/S0002939414715259/fulltext\u003c/li\u003e\n\u003cli\u003eElkbuli A, Meneses E, Kinslow K, McKenney M, Boneva D. A rare case of pre-hospital globe enucleation after a penetrating injury to the orbit during an assault: A case report and literature review. Int J Surg Case Rep [Internet]. 2020 Jan 1 [cited 2024 May 31];75:231. Available from: /pmc/articles/PMC7509343/\u003c/li\u003e\n\u003cli\u003eShafa S, Zand A, Sharifi A, Sharifzadeh M. Traumatic Globe Enucleation After Blunt Head Injury. Cureus [Internet]. 2022 Apr 25 [cited 2024 Jun 10];14(4). Available from: /pmc/articles/PMC9132745/\u003c/li\u003e\n\u003cli\u003eLundin AM, Azari AA, Kanavi MR, Potter HD, Lucarelli MJ, Burkat CN, et al. Ocular trauma resulting in enucleation: A 12-year experience from a large regional institution. Wis Med J [Internet]. 2014;113(3):99\u0026ndash;101. Available from: http://www.useironline.org/epidemiology.\u003c/li\u003e\n\u003cli\u003eFan AH. Autoenucleation: A Case Report and Literature Review. Psychiatry (Edgmont) [Internet]. 2007 Oct [cited 2024 Jun 10];4(10):60. Available from: /pmc/articles/PMC2860527/\u003c/li\u003e\n\u003cli\u003ePatton N. Self-inflicted eye injuries: a review. Eye [Internet]. 2004 [cited 2024 Jun 10];18:867\u0026ndash;72. Available from: www.nature.com/eye\u003c/li\u003e\n\u003cli\u003ede Moraes ATL, Quaresma MCA, Silva TF, Sousa NWA, Menezes SAF, Ribeiro ALR, et al. Traumatic enucleation of the left globe after a road traffic accident \u0026ndash; A case report of an uncommon occurrence in maxillofacial trauma. Int J Surg Case Rep [Internet]. 2021 Jan 1 [cited 2024 Jun 8];78:133. Available from: /pmc/articles/PMC7750125/\u003c/li\u003e\n\u003cli\u003eValeshabad AK, Naseripour M, Asghari R, Parhizgar SH, Parhizgar SE, Taghvaei M, et al. Enucleation and evisceration: indications, complications and clinicopathological correlations. Int J Ophthalmol [Internet]. 2014 [cited 2024 Jun 10];7(4):677. Available from: /pmc/articles/PMC4137206/\u003c/li\u003e\n\u003cli\u003eUnal S, Argin A, Arslan E, Demirkan F, Aksoy A. Bilateral Complete Avulsion of Ocular Globes in a Le Fort III Maxillofacial Fracture: A Case Report and Review of the Literature. https://doi.org/101177/112067210501500119 [Internet]. 2005 Jan 1 [cited 2024 Jun 10];15(1):123\u0026ndash;5. Available from: https://journals.sagepub.com/doi/10.1177/112067210501500119?url_ver=Z39.88-2003\u0026amp;rfr_id=ori%3Arid%3Acrossref.org\u0026amp;rfr_dat=cr_pub++0pubmed\u003c/li\u003e\n\u003cli\u003eGurram P, Ramakrishnan K, Vivek N, Chandran S, Parthasarathy P, Kumar DS. Complete Globe Avulsion in a 13-Year-Old Young Boy with Maxillofacial Injury: A Case Report and Review of Literature. https://doi.org/101055/s-0038-1667068 [Internet]. 2018 Jan 1 [cited 2024 Jun 12];2(1):s-0038-1667068. Available from: https://journals.sagepub.com/doi/10.1055/s-0038-1667068?icid=int.sj-full-text.similar-articles.8\u003c/li\u003e\n\u003cli\u003eSanborn G, Gonder J, \u0026hellip; RG-C journal of, 1984 undefined. Evulsion of the optic nerve: a clinicopathological study. Eur Sanborn, JR Gonder, RE Goldberg, WE Benson, S KesslerCanadian J Ophthalmol J Can d\u0026rsquo;ophtalmologie, 1984\u0026bull;europepmc.org [Internet]. [cited 2024 Jun 12]; Available from: https://europepmc.org/article/med/6713263\u003c/li\u003e\n\u003cli\u003eKeys J, Dempster M, Jackson J, Williams M, Coyle S. The psychosocial impact of losing an eye through traumatic injury and living with prosthetic restoration: A thematic analysis. Acta Psychol (Amst). 2021 Sep 1;219:103383. \u003c/li\u003e\n\u003cli\u003ePine K. The Impact of Eye Loss and Prosthetic Eye Wear on Recreational, Occupational and Social Areas of Functioning. J Ophthalmol Vis Sci [Internet]. 2017 [cited 2024 Jun 12];2(1). Available from: www.austinpublishinggroup.com\u003c/li\u003e\n\u003cli\u003eBachani AM, Peden M, Gururaj G, Norton R, Hyder AA. Road Traffic Injuries. Dis Control Priorities, Third Ed (Volume 7) Inj Prev Environ Heal [Internet]. 2017 Oct 27 [cited 2024 Jun 12];35\u0026ndash;54. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525212/\u003c/li\u003e\n\u003cli\u003eStates JD. The prevention of injury secondary to motor vehicle accidents. Clin Orthop Relat Res. 1987;222:21\u0026ndash;9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"traumatic enucleation, road traffic accident, artificial eyes implant.","lastPublishedDoi":"10.21203/rs.3.rs-4618201/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4618201/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTraumatic enucleation is a rare consequence of high-impact trauma. It is a severe injury leading to permanent loss of vision. One of the most common causes of traumatic globe enucleation is automobile accidents. This damage may have a severe effect on the patient's physical and mental health. Apart from the permanent loss of vision in the affected eye with traumatic enucleation, some complications, including pseudoptosis, orbital infection, hemorrhages, and scarring can occur. Traumatic enucleation may also be complicated by psychological problems like stigma, depression, anxiety, and post-traumatic stress disorder. However, following enucleation, patients might be given a prosthetic eye to help them appear like normal eyes once more and prevent psychological problems.\u003c/p\u003e \u003cp\u003eThe goal of this case report is to highlight the potential occurrence of traumatic enucleation following a road traffic accident, as well as to describe the appropriate management of patients who present with this condition including the role of artificial eye implants in the management of such patients.\u003c/p\u003e","manuscriptTitle":"Improving the Care Outcomes of Traumatic Enucleation with Artificial Eye Implant: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-31 19:49:10","doi":"10.21203/rs.3.rs-4618201/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5905013b-ea80-4ee8-b916-fca5bf06080a","owner":[],"postedDate":"July 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-02T08:15:44+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-31 19:49:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4618201","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4618201","identity":"rs-4618201","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}