Traumatic retrobulbar hematoma is a serious complication that should be recognized in the ed. In this article, two cases of retrobulbar hematoma after surgical repair of blowout fracture are reported. Recent background animal and human research is summarized. Epidural hematoma trh11 3 diagnosis for other diagnostic evaluation see p. Introduction acute retrobulbar haemorrhage rbh with orbital compartment syndrome is a sightthreatening ophthalmic emergency requiring treatment with lateral canthotomy and cantholysis lcc. Patient was attacked by his 3 year old son one week earlier, now presents with right eye swelling. Spontaneous orbital haemorrhage is a very rare condition and visionthreatening event. Due to the high stakes and urgency of this complication, teaching this in the clinical setting is difficult. A retrobulbar block is deeper and uses less volume than a peribulbar block. In this case, spontaneous hemorrhage due to anticoagulation was believed to be the.
Haemorrhage and risk factors associated with retrobulbar. The prevalence of retrobulbar haemorrhage after retrobulbar injection has been reported to vary from 0. To view chapter written summaries, you need to subscribe. Retrobulbar haemorrhage pdf ocular, orbital and periorbital neoplastic conditions of the horse. Retrobulbar hemorrhage, especially when associated with visual loss, is a rare but significant complication after facial bone reconstruction.
Treatment of retrobulbar hemorrhage includes lateral canthotomy and cantholysis, which have been shown to reduce iop an average of 14. Lcc is a simple, visionsaving procedure that can be performed by emergency physicians. Neurological damage is caused by direct compression, by bony fragments or by an indirect compression of the nerves caused by hemorrhage rowe and williams 1985 5. Optic nerve ischemia is identified as the likely cause of visual impairment. Blood found behind the globe but within the orbit, mostly occurring secondary to trauma, which can lead to optic nerve and retinal ischemia and ultimately, vision loss. It may lead to a compressive hematoma, which can threaten retinal perfusion. Bashed, blind and bulging litfl ophthalmology befuddler. Although a retrobulbar hemorrhage reportedly occurs in less than 2% of retrobulbar anesthetic injections, it may result in a devastating loss of vision by compression of the circulation. Visual diagnosis in emergency medicine early detection of traumatic retrobulbar hemorrhage using bedside ocular ultrasound carol katherine kniess, do, tiffany c. There is hemorrhage arrow of the retrobulbar region. Lcc will reduce the pressure exerted on the orbit by.
Retrobulbar hemorrhage is typically associated with significant facial or orbital trauma, and spontaneous hemorrhage is a very rare cause of orbital compartment syndrome. We have moved a full circle from the ancient days of no. The most severe reported complication was retrobulbar hematoma occurring in 3. Retrobulbar hemorrhage retrobulbar hemorrhage is an ophthalmic emergency during which damage to the ophthalmic artery causes massive hemorrhage leading to engorgement of vessels, proptosis, tight eyelids, and a rise in intraocular pressure.
Although this is a rare complication, it requires considerable caution because it can cause blindness. Anesthesia for cataract surgery today aims at creating a comfortable environment for the patient and the surgeon during surgery and a quick recovery of function without inherent added risks. Retrobulbar hemorrhage is typically caused by an inadvertent arterial puncture. Local ocular include hematoma formation, which is the most common complication seen because of inadvertant puncture of vessels within the retrobulbar space, perforation of the globe and neuritis. Retrobulbar hemorrhage is a rare entity characterized by an acute increase in pressure in the orbital space for example, orbital compartment syndrome due to sudden bleeding behind the eye. Derek c knottenbelt primary neoplasia of the eyelids is common in horses even though the. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Retrobulbar hematoma rh is a rare but devastating complication of sinus surgery. Because orbital compartment syndrome can compromise. At the time of hemorrhage, it is imperative to have an ophthalmologist present who can monitor intraocular pressure and take the appropriate steps to preserve central retinal artery. Retrobulbar hemorrhage is an ophthalmic emergency during which damage to the ophthalmic artery causes massive hemorrhage leading to engorgement of vessels, proptosis, tight eyelids, and a rise in intraocular pressure. It should not delay surgical treatment if there is visual loss.
Pdf retrobulbar hematoma in blowout fracture after open. Case report spontaneous retrobulbar haematoma mehmetdeveer, 1 nesatcullu, 1 halilbeydilli, 2 hamdisozen, 3 onderyeniceri, 4 andselcukparlak 5 department of radiology, mugla sitki kocman university school of medicine, mugla, turkey. Retrobulbar haemorrhage with acute orbital compartment syndrome is primarily a clinical diagnosis ct orbit axial and coronal views can confirm the diagnosis but if vision is threatened treat first usual findings on ct. Retrobulbar hematoma is a condition that involves blood congestion deep in the soft tissue of the posterior orbital septum. Orbital hemorrhage is the most common cause of orbital compartment syndrome, usually occurring secondary to trauma, surgery, or retrobulbar injection. Warfarin, acetylsalicylic acid and nsaids were stopped 14 days before surgery. He was healthy with no history of medical problems or bleeding disorders, and he was not taking any medications. A retrobulbar block is a regional anesthetic nerve block in the retrobulbar space, the area located behind the globe of the eye. Pathophysiology of orbital compartment syndrome normal intraorbital pressure is 36 mm hg 10,11. Retrobulbar hemorrhages may occur from facial trauma, orbital surgery, and peribulbar or retrobulbar injections. Signs of retrobulbar hemorrhage include proptosis, ophthalmoplegia, increased intraocular pressure, loss of pupillary reflexes, and optic disc or. Spontaneous retrobulbar hemorrhage mdedge emergency. Retrobulbar blocks can lead to retrobulbar hemorrhage, crao, optic nerve injury, perforated globe esp.
Specific recommendations for avoidance and management of acute retrobulbar hematoma are offered. Reilly, do, and chaiya laoteppitaks, md department of emergency medicine, einstein medical center philadelphia, philadelphia, pennsylvania. Retrobulbar hematoma orbital compartment syndrome definition. Retrobulbar hematoma is a diagnostic and therapeutic emergency and must be treated urgently to prevent permanent blindness. Pdf retrobulbar hematoma from warfarin toxicity and the. This is the most common complication seen and is due. Retrobulbar haemorrhage cpg v1 20102015 3 medical management medical management may be considered in conjunction with immediate surgical management.
Blunt trauma to the face or globe can cause bleeding in the retrobulbar space, which quickly causes an. Figure 1 eye, retrobulbar hemorrhage in a male f344n rat from a chronic study. Retrobulbar hematoma definition of retrobulbar hematoma. Retrobulbar haematoma following blunt orbital trauma is a rare, but potentially serious, complication, since it can evolve rapidly from visual impairment to permanent loss of vision. Factors related to patient outcomes, however, are unknown. Retrobulbar hematoma from warfarin toxicity and the limitations of bedside ocular sonography article pdf available in the western journal of emergency medicine 112. Retrobulbar hematoma from warfarin toxicity and the limitations of bedside ocular sonography. Retrobulbar haemorrhage clinical practice guideline. However, such cases may present to nonophthalmic emergency departments ed outofhours, when specialist intervention is not readily available. Retrobulbar hemorrhage resulting in vision loss is an uncommon but devastating complication of any procedure or operation involving the eyelids or the orbit. Pdf traumatic and iatrogenic retrobulbar hemorrhage. In addition to the patients high iop at presentation, another concern was the continued hemorrhaging from both the incision site and. In one patient, permanent loss of vision was involved, but with the other patient, we were able to prevent this by performing immediate.
This injection provides akinesia of the extraocular muscles by blocking cranial nerves ii, iii, and vi, thereby preventing movement of. Trh1 lp is absolutely contraindicated csf pressure 200 mmh 2 o, csf clear bloody if there was contusion or laceration of brain skull xray may show associated skull fracture e. Since the etiology of a retrobulbar hemorrhage is multiple including trauma, a sequalae of ophthalmic surgery, retrobulbar. With any retrobulbar hematoma, one must be concerned for orbital compartment syndrome. Although the incidence of retrobulbar hemorrhage is low, its association with blindness is significant with estimates nearing as high as around 48% 1. A rare complication of blepharoplasty, in which a pocket of blood forms behind the eyeball. Complications of retrobulbar blocks continued coagulation this block is appropriate for patients with no significant bleeding or coagulation disorders. A retrobulbar block does not anesthetize cranial nerve vii facial nerve, which leaves the patient able to close the eye with the orbicularis oculi cn vii but not open it with the levator muscle cn iii.
This sightthreatening situation most commonly arises from orbital bleeding accompanying undisplaced fractures of the orbital walls, an event that increases the pressure inside the orbit. It is treated initially with a lateral canthotomy and cantholysis at the bedside. Retrobulbar hemorrhage an overview sciencedirect topics. Local and regional anesthesia for ophthalmic surgery nysora. Complications associated with this block are either local or systemic.
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