Retrobulbar hemorrhage: Difference between revisions

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*Also known as retrobulbar hematoma
*Also known as retrobulbar hematoma
*Most often due to [[blunt orbital trauma]]
*Most often due to [[blunt orbital trauma]]
**Can also be 2/2 spontaneous bleeding
**Can also be secondary to spontaneous bleeding<ref name="RBHTA" />
*Can cause loss of vision due to abrupt increase in intraocular pressure → orbital compartment syndrome (OCS)
*Can cause loss of vision within 60-120 min due to abrupt increase in intraocular pressure → orbital compartment syndrome (OCS)


==Clinical Features==
==Clinical Features==
*Pain
[[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]]
==Diagnosis==
**(Do not perform tonometry if globe rupture is suspected)
*CT Orbit
*Tonometry
**Only measure once globe rupture has been ruled-out


==Differential Diagnosis==
==Differential Diagnosis==
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{{Periorbital swelling DDX}}
{{Periorbital swelling DDX}}


==Treatment==
==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
*Emergent ophthalmology consultation
*Consider lateral [[canthotomy]] and cantholysis, if indicated
*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==
==Disposition==
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<references/>
<references/>


[[Category:Ophtho]]
[[Category:Ophthalmology]]

Revision as of 20:37, 26 September 2020

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

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.