Retrobulbar hemorrhage: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* | [[File:PMC3700149 NJMS-3-152-g008.png|thumb|Retrobulbar hemorrhage]] | ||
*Proptosis | *[[Eye pain]] | ||
*Decreased visual acuity | *[[Proptosis]] | ||
*Elevated IOP | *[[Visual loss|Decreased visual acuity]] | ||
*Elevated [[IOP]] | |||
**(Do not perform tonometry if globe rupture is suspected) | **(Do not perform tonometry if globe rupture is suspected) | ||
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{{Periorbital swelling DDX}} | {{Periorbital swelling DDX}} | ||
== | ==Evaluation== | ||
[[File:PMC2908661 wjem-11-208f2.png|thumb|Computed tomography demonstrating left retrobulbar hemorrhage with proptosis.]] | |||
*CT Orbit | *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> | *[[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 | *Consider [[lateral canthotomy]] and cantholysis, if indicated | ||
*Emergent ophthalmology consultation | *Emergent ophthalmology consultation | ||
*Consider medical | *Consider medical management in conjunction with cantholysis | ||
**20% mannitol 2 g/kg IV | **20% [[mannitol]] 2 g/kg IV | ||
**methylprednisolone, | **[[methylprednisolone]], 250mg IV or hydrocortisone 100mg IV | ||
**acetazolamide, 250 to | **[[acetazolamide]], 250 to 500mg IV | ||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Ocular compartment syndrome]] | |||
*[[Orbital Blowout Fracture]] | *[[Orbital Blowout Fracture]] | ||
*[[Canthotomy]] | *[[Canthotomy]] | ||
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<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.