Retrobulbar bleeding

Retrobulbar Hemorrhage is a medical condition characterized by the accumulation of blood within the orbit behind the eye, specifically behind the bulbus oculi (globe of the eye). This condition is considered an ophthalmic emergency and requires immediate attention to prevent lasting damage to vision. Retrobulbar hemorrhage is most commonly associated with trauma to the eye or orbit, but can also occur spontaneously or as a complication of surgical procedures around the eye.

Causes

Retrobulbar hemorrhage can be caused by several factors, including:

• Trauma: Blunt or penetrating injuries to the eye or orbit can lead to bleeding behind the eye.
• Surgical Complications: Procedures such as orbital surgery, facial surgery, or even dental procedures can inadvertently cause bleeding in the retrobulbar space.
• Vascular Abnormalities: Conditions like aneurysms or vascular malformations within the orbit can lead to spontaneous hemorrhage.
• Blood Dyscrasias: Disorders affecting the blood's ability to clot can predispose individuals to bleeding, including in the retrobulbar space.

Symptoms

Symptoms of retrobulbar hemorrhage may include:

• Sudden onset of pain behind the eye
• Proptosis (protrusion of the eye)
• Decreased visual acuity or loss of vision
• Diplopia (double vision)
• Restricted eye movement
• Increased intraocular pressure
• Ecchymosis (bruising) of the eyelids or surrounding tissues

Diagnosis

Diagnosis of retrobulbar hemorrhage is primarily clinical, based on the patient's history and physical examination. Imaging studies, such as a CT scan or MRI of the orbit, can be helpful in confirming the diagnosis and assessing the extent of the hemorrhage.

Treatment

The treatment of retrobulbar hemorrhage aims to relieve pressure within the orbit to prevent damage to the optic nerve and restore normal blood flow to the eye. Treatment options include:

• Immediate Medical Management: High-dose systemic corticosteroids may be administered to reduce inflammation and swelling.
• Surgical Intervention: In cases where conservative management fails or vision deteriorates rapidly, surgical decompression of the orbit may be necessary. This can involve a lateral canthotomy and cantholysis, procedures that relieve pressure by cutting the lateral canthal tendon.
• Supportive Care: Analgesics for pain management and monitoring of intraocular pressure and visual acuity are important aspects of care.

Prevention

Preventing retrobulbar hemorrhage involves minimizing risk factors associated with its causes. Protective eyewear can help prevent trauma-induced cases, while careful surgical planning and technique are crucial in reducing the risk of hemorrhage during procedures around the orbit.

Prognosis

The prognosis for individuals with retrobulbar hemorrhage depends on the severity of the hemorrhage and the promptness of treatment. Early intervention can lead to a good recovery of vision, but delays in treatment can result in permanent vision loss or blindness.