Retro-Orbital Hematoma

Basics

Also known as retrobulbar hematoma
Rare complication of orbital trauma and facial surgery
Collection of blood behind the globe causing increased retro-orbital pressure leading to tissue ischemia
Vision loss can occur within 90 min if not diagnosed and treated with irreversible damage at 120 min
A sight-saving procedure called lateral canthotomy is often needed to be performed in the ED
A thorough exam is needed as many patients with ROH may be unconscious
Frequent repeat exams are mandatory due to hematoma progression

Incidence is difficult to estimate because ROH can be from multiple causes, both traumatic and iatrogenic:
- 0.45–3% of blunt or penetrating trauma
- 0.45–0.6% coexist with orbital wall fractures
- 0.0052% of blepharoplasty
- 0.3% of surgical facial fracture repair
- 0.006% of endoscopic sinus surgery
True incidence has been debated as only slightly more than half of diagnosed retro-orbital hemorrhage has been confirmed either with a preceding CT scan or with the presence of an evacuated hematoma

Trauma to the globe or orbital walls and the orbital plexus
Rapid increasing pressure behind the orbit secondary to hematoma formation impedes venous outflow and arterial inflow to the retina and the optic nerve to cause orbital compartment syndrome
There may also be a stretching to the optic nerve as the patient develops proptosis which contributes to the decrease in visual acuity

There's more to see -- the rest of this topic is available only to subscribers.