- Also known as retrobulbar hematoma
- Most often due to blunt orbital trauma
- Can also be secondary to spontaneous bleeding
- Can cause loss of vision within 60-120 min due to abrupt increase in intraocular pressure → orbital compartment syndrome (OCS)
- Eye pain
- Decreased visual acuity
- Elevated IOP
- (Do not perform tonometry if globe rupture is suspected)
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Normal IOP
- Increased IOP
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Granulomatosis with polyangiitis
- CT Orbit
- Ocular ultrasound
- Diagnosis of retrobulbar pathology via ultrasound is technically difficult, has not been validated in the clinical setting and false-negatives have been reported - therefore, CT should remain the standard diagnostic tool for suspected retrobulbar pathology.
- Consider lateral canthotomy and cantholysis, if indicated
- Emergent ophthalmology consultation
- Consider medical management in conjunction with cantholysis
- 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.