Retrobulbar hemorrhage

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

Retrobulbar hemorrhage

Differential Diagnosis

Maxillofacial Trauma

Periorbital swelling

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

Disposition

  • Admit

Medication Dosing

Mannitol 2g/kg IV (20% solution) IV Methylprednisolone 250mg IV IV Acetazolamide 250-500mg IV IV

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.
This page is issued from WikEM. The text is available under an unknown license unless otherwise noted. Additional terms may apply for the media files.