Case ReportOCCULT GLOBE PERFORATION DURING MEDIAL CANTHOPEXYManjunath, Deepa BA; Kaiser, Peter K. MD; Ehlers, Justis P. MDAuthor Information Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio. Reprint requests: Justis P. Ehlers, MD, 9500 Euclid Avenue/i32, Cleveland, OH 44195; e-mail: email@example.com Supported by NIH/NEI K23-EY022947-01A1 (J.P.E.); Ohio Department of Development TECH-13-059 (J.P.E.); and Research to Prevent Blindness (Cole Eye Institutional). P. K. Kaiser: Zeiss (C), Topcon (C), Alcon (C), Novartis (C), Bausch and Lomb (C); J. P. Ehlers: Bioptigen (C, P), Thrombogenics (C, R), Synergetics (P), Genentech (R), Leica (C), Zeiss (C), Alcon (C). D. Manjunath has no financial/conflicting interests to disclose. Retinal Cases & Brief Reports: Summer 2018 - Volume 12 - Issue 3 - p 231-233 doi: 10.1097/ICB.0000000000000482 Buy Metrics AbstractIn Brief Purpose: To report a case of occult globe perforation following craniofacial surgery. Methods: A 16-year-old girl presented with vision loss and hypotony of her left eye following a craniofacial procedure, including bilateral medial canthopexy. This report describes the evaluation and findings following the craniofacial surgery. Results: After recognition of vision loss and concern for rupture, surgical exploration was performed by an ophthalmologist at an outside institution on suspicion of globe penetration/perforation. Surgical exploration did not identify any scleral entry/exit sites. She was then referred for vitreoretinal consultation. Serous choroidal detachments and associated retinal detachment were identified on ultrasound. The patient was maintained on her postoperative oral antibiotics and followed closely. As the intraocular pressure improved, the choroidals began to resolve. Two retinal break sites were identified on opposite sides of the globe in the retinal periphery. Laser retinopexy was performed at the two penetration sites. The patient recovered excellent vision without any additional complications. Conclusion: Early recognition and high suspicion of globe injury is critical in cases of postoperative vision loss following craniofacial surgery. Occult globe perforation is a potential devastating complication of craniofacial surgery and must be suspected in cases of postoperative vision loss. Early recognition is critical to address any traumatic sequelae and maximize chances for optimal recovery.