II. Pathophysiology
-
Trauma to eye results in infraorbital artery distribution Hemorrhage
- Even minor Trauma may result in Retrobulbar Hematoma for those with bleeding risk (e.g. Anticoagulation)
- Orbit is a closed space
- Surrounded by bone in all planes except anteriorly
- Anterior margin is blocked by the medial and lateral canthal tendons which hold the globe in the orbit
- Hemorrhage results in increased orbital pressures
-
Compartment Syndrome results if these pressures are not decompressed
- Compression of artery and Optic Nerve
- Retinal ischemia results when Intraocular Pressure increases above central Retinal artery pressure
- Irreversible injury may start within 60-90 minutes of ischemia onset
III. Signs: Unilateral Findings
- Eye Pain
- Decreased Visual Acuity
- Proptosis
- Diffuse Subconjunctival Hemorrhage
- Decreased Extraocular Movement
- Increased introcular pressure >40 mmHg
- Globe feels "hard as a rock"
- Avoid applying significant pressure to eye
- Afferent pupil defect
- Associated with Optic Nerve injury
- Difficult Eyelid opening
IV. Imaging
- CT Head
- Bedside Orbital Ultrasound
- Exercise caution to prevent significant pressure on globe
V. Management: General
- Emergent opthalmology Consultation for surgical decompression
- Emergent Lateral Canthotomy (see below) if indicated
VI. Management: Lateral Canthotomy Indications
- See Lateral Canthotomy
- Retrobulbar Hematoma and
- Primary indications
- Secondary indications
- Afferent Pupillary Defect (see Orbital Ultrasound)
- Eye Pain
- Funduscopic changes
- Cherry red Macula
- Pallor of the nerve head
VII. References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
- Werner and St Peter in Swadron (2023) EM:Rap 23(4): 7-8
- Peak in O'Connor (2012) Medscape: EMedicine
- Wu in Herbert (2012) EM:Rap 12(11):11-12
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | Hemorrhage within the orbital cavity, posterior to the eyeball. |
| Concepts | Pathologic Function (T046) |
| MSH | D019315 |
| SnomedCT | 194179009 |
| English | Hemorrhage, Retrobulbar, Retrobulbar Hemorrhage, Retrobulbar Hemorrhages, Retrobulbar Hemorrhage [Disease/Finding], retrobulbar haemorrhage, retrobulbar hemorrhage, Retrobulbar haematoma, Retrobulbar haemorrhage, Retrobulbar hematoma, Retrobulbar hemorrhage, Retrobulbar hemorrhage (disorder) |
| Swedish | Retrobulbär blödning |
| Czech | retrobulbární hemoragie |
| Finnish | Silmämunantakainen verenvuoto |
| Russian | GEMORRAGIIA RETROBUL'BARNAIA, RETROBUL'BARNOE KROVOIZLIIANIE, RETROBUL'BARNAIA GEMORRAGIIA, ГЕМОРРАГИЯ РЕТРОБУЛЬБАРНАЯ, РЕТРОБУЛЬБАРНАЯ ГЕМОРРАГИЯ, РЕТРОБУЛЬБАРНОЕ КРОВОИЗЛИЯНИЕ |
| Polish | Krwotok pozagałkowy |
| Japanese | 眼窩内出血, 球後出血, 眼球後部出血, 出血-球後, 出血-眼球後部, 出血-眼窩内 |
| Norwegian | Retrobulbær hemoragi, Retrobulbær blødning |
| Spanish | hemorragia retrobulbar (trastorno), hemorragia retrobulbar, Hemorragia Retrobulbar |
| French | Hémorragie rétrobulbaire |
| German | Blutung, retrobulbäre, Hämorrhagie, retrobulbäre, Retrobulbäre Blutung |
| Italian | Emorragia retrobulbare |
| Dutch | Bloeding, retrobulbaire, Retrobulaire bloeding |
| Portuguese | Hemorragia Retrobulbar |
