Retro-Orbital Hematoma

Retro-Orbital Hematoma is a topic covered in the 5-Minute Emergency Consult.

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  • 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 emergency department
  • 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

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