Retrobulbar hemorrhage

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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

  • Pain
  • Proptosis
  • Decreased visual acuity
  • Elevated IOP
    • (Do not perform tonometry if globe rupture is suspected)

Differential Diagnosis

Maxillofacial Trauma

Periorbital swelling

Proptosis

No proptosis

Lid Complications

Other

Evaluation

  • CT Orbit
  • Ocular ultrasound[2][3][4]
    • Dx 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 mangement in conjunction with cantholysis
    • 20% mannitol 2 g/kg IV
    • methylprednisolone, 250mg IV or hydrocortisone 100mg IV
    • acetazolamide, 250 to 500mg IV

Disposition

  • Admit

See Also

References

  1. 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.
  2. 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.
  3. Kilker BA, Holst JM, Hoffmann B. Bedside ocular ultrasound in the emergency department. Eur J Emerg Med. 2014 Aug;21(4):246-53.
  4. 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.