Retrobulbar hemorrhage: Difference between revisions
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==Background== | ==Background== | ||
*Most often due to blunt trauma | *Also known as retrobulbar hematoma | ||
*Can cause loss of vision due to abrupt increase in intraocular pressure | *Most often due to [[blunt orbital trauma]] | ||
**Can also be secondary to spontaneous bleeding<ref name="RBHTA" /> | |||
*Can cause loss of vision within 60-120 min due to abrupt increase in intraocular pressure → orbital compartment syndrome (OCS) | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:PMC3700149 NJMS-3-152-g008.png|thumb|Retrobulbar hemorrhage]] | |||
*[[Eye pain]] | |||
*[[Proptosis]] | |||
*[[Visual loss|Decreased visual acuity]] | |||
*Elevated [[IOP]] | |||
**(Do not perform tonometry if globe rupture is suspected) | |||
==Diagnosis== | ==Differential Diagnosis== | ||
{{Maxillofacial trauma DDX}} | |||
{{Periorbital swelling DDX}} | {{Periorbital swelling DDX}} | ||
== | ==Evaluation== | ||
[[File:PMC2908661 wjem-11-208f2.png|thumb|Computed tomography demonstrating left retrobulbar hemorrhage with proptosis.]] | |||
*CT Orbit | |||
*[[Ocular ultrasound]]<ref>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.</ref><ref>Kilker BA, Holst JM, Hoffmann B. Bedside ocular ultrasound in the emergency department. Eur J Emerg Med. 2014 Aug;21(4):246-53.</ref><ref>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.</ref> | |||
**Diagnosis of retrobulbar pathology via ultrasound is technically difficult, has not been validated in the clinical setting and false-negatives have been reported<ref name="RBHTA">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.</ref> - 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 | |||
**20% [[mannitol]] 2 g/kg IV | |||
**[[methylprednisolone]], 250mg IV or hydrocortisone 100mg IV | |||
**[[acetazolamide]], 250 to 500mg IV | |||
==Disposition== | |||
*Admit | |||
==See Also== | ==See Also== | ||
*[[Ocular compartment syndrome]] | |||
*[[Orbital Blowout Fracture]] | *[[Orbital Blowout Fracture]] | ||
*[[Canthotomy]] | *[[Canthotomy]] | ||
| Line 26: | Line 42: | ||
*[[Blunt Eye Trauma]] | *[[Blunt Eye Trauma]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Ophthalmology]] | ||
Latest revision as of 12:55, 24 July 2021
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
- Eye pain
- Proptosis
- Decreased visual acuity
- Elevated IOP
- (Do not perform tonometry if globe rupture is suspected)
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Periorbital swelling
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Ocular compartment syndrome
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
Evaluation
- 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
- 20% mannitol 2 g/kg IV
- methylprednisolone, 250mg IV or hydrocortisone 100mg IV
- acetazolamide, 250 to 500mg IV
Disposition
- Admit
See Also
- Ocular compartment syndrome
- Orbital Blowout Fracture
- Canthotomy
- Eye Algorithm (Main)
- Blunt Eye Trauma
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.