A 58-year-old woman was involved in a subway accident. On arrival at the hospital 2 hours after the injury, the right direct light reflex was sluggish and a mild relative afferent pupillary defect was present. Her right visual acuity could not be assessed because of her decreased consciousness. Funduscopic examination revealed no cherry-red spot. CT revealed a right lateral orbital wall fracture (Fig. 1). The fractured bone (asterisk) pushed the orbital contents anteromedially, resulting in globe tenting (arrow), with a posterior globe angle of 120°. Orbital edema or emphysema was not noted. The authors urgently performed a lateral canthotomy and cantholysis, followed by a fracture reduction. One month after the surgery, the right direct light reflex was prompt and complete with resolution of the relative afferent pupillary defect, and her right visual acuity was 1.0.

Globe tenting is a sign of abrupt, high-grade proptosis characterized by a conical posterior globe margin. A sudden increase in the retrobulbar pressure in the confined orbital space displaces the globe anteriorly. In such situations, optic nerve function can be decreased by excessive stretching of the nerve and reduction in the intraorbital perfusion.

Periocular trauma is the most common cause of injuries leading to globe tenting. Orbital hematoma, edema, and emphysema are common causes of traumatic globe tenting. Globe tenting may potentially occur as a result of trauma to the lateral orbital wall; however this has not been previously reported. To the best if the authors’ knowledge, this case is the first showing traumatic globe tenting due to a displaced lateral orbital wall fragment.