Retrobulbar Haemorrhage

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Symptoms

  • Pain, visual impairment, difficulty opening eyes due to swollen eyelids
  • After trauma or surgery

Examination

  • Visual impairment?
  • Relative afferent pupillary defect (RAPD)? Ishihara test?
  • Exophthalmos?
  • Motility?
  • Tense eyelids, difficult to open
  • Resistance to retropulsion
  • Elevated intraocular pressure?
  • Optic disc swelling, choroidal folds, pulsations of the central artery

Suspected Orbital Compartment Syndrome

  • Immediate lateral canthotomy and cantholysis
  • Clinical Diagnosis! No Imaging (CT) that could delay treatment

In case of unclear findings

  • Consider CT orbit: often no clearly delineated haemorrhage visible, typical signs include a maximally stretched optic nerve with posterior traction on the eyeball (teardrop shape, especially if the scleral angle is <130°)
  • Regular visual tests, especially in the first 4-6 hours, as the risk of orbital compartment syndrome is highest during this time
  • Plan outpatient lid reconstruction within 2 weeks

Sources

  • EyeWiki Retrobulbar hemorrhage
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)