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Background
- Also known as retrobulbar hematoma
- Most often due to blunt orbital trauma
- Can also be secondary to spontaneous bleeding[1]
- Can cause loss of vision within 60-120 min due to abrupt increase in intraocular pressure → orbital compartment syndrome (OCS)
Clinical Features
Differential Diagnosis
Proptosis
No proptosis
Lid Complications
Other
Evaluation
Computed tomography demonstrating left retrobulbar hemorrhage with proptosis.
- CT Orbit
- Ocular ultrasound[2][3][4]
- Diagnosis of retrobulbar pathology via ultrasound is technically difficult, has not been validated in the clinical setting and false-negatives have been reported[1] - therefore, CT should remain the standard diagnostic tool for suspected retrobulbar pathology.
Management
- Consider lateral canthotomy and cantholysis, if indicated
- Emergent ophthalmology consultation
- Consider medical management in conjunction with cantholysis
Disposition
See Also
References
- ↑ 1.0 1.1 Thompson D, Stanescu C, Pryor P, Laselle B. Retrobulbar Hematoma from Warfarin Toxicity and the Limitations of Bedside Ocular Sonography. Western Journal of Emergency Medicine. 2010;11(2):208-210.
- ↑ Blaivas M, Theodoro D, Sierzenski PR. A study of bedside ocular ultrasonography in the emergency department. Acad Emerg Med. 2002 Aug;9(8):791-9.
- ↑ Kilker BA, Holst JM, Hoffmann B. Bedside ocular ultrasound in the emergency department. Eur J Emerg Med. 2014 Aug;21(4):246-53.
- ↑ Estevez A, Deutch J, Sturmann K, et al. Ultrasonography evaluation of retrobulbar hematoma in bovine orbits. Acad Emerg Med. 2000 Oct;7(10):1169-70.
