II. Pathophysiology

  1. Trauma to eye results in infraorbital artery distribution Hemorrhage
  2. Orbit is a closed space
    1. Surrounded by bone in all planes except anteriorly
    2. Anterior margin is blocked by the medial and lateral canthal tendons which hold the globe in the orbit
  3. Hemorrhage results in increased orbital pressures
  4. Compartment Syndrome results if these pressures are not decompressed
    1. Compression of artery and Optic Nerve
    2. Retinal ischemia results when Intraocular Pressure increases above central Retinal artery pressure
      1. Irreversible injury may start within 60 minutes of ischemia onset

III. Signs

  1. Eye Pain
  2. Decreased Visual Acuity
  3. Proptosis
  4. Subconjunctival Hemorrhage
  5. Decreased Extraocular Movement
  6. Increased introcular pressure
  7. Afferent pupil defect
    1. Associated with Optic Nerve injury

IV. Imaging

  1. CT Head
  2. Bedside Orbital Ultrasound
    1. Exercise caution to prevent significant pressure on globe

V. Management: General

  1. Emergent opthalmology Consultation for surgical decompression
  2. Emergent Lateral Canthotomy (see below) if indicated

VI. Management: Lateral Canthotomy Indications

  1. Retrobulbar Hematoma and
  2. Primary indications
    1. Proptosis
    2. Intraocular Pressure >40 mmHg
    3. Decreased Visual Acuity
  3. Secondary indications
    1. Afferent Pupillary Defect (see Orbital Ultrasound)
    2. Eye Pain
    3. Funduscopic changes
      1. Cherry red Macula
      2. Pallor of the nerve head

VII. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21
  2. Peak in O'Connor (2012) Medscape: EMedicine
    1. http://emedicine.medscape.com/article/799528-overview#showall
  3. Wu in Majoewsky (2012) EM:Rap 12(11):11-12

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Retrobulbar Hemorrhage (C0302497)

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
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