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H. Ho, J. K. Han, S. A. Newman; Management of Retrobulbar Hematoma. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5271.
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Retrobulbar hematoma (RH) is a serious complication resulting from both otolaryngic and ophthalmologic procedures. RH is a possibility during endoscopic sinus surgery and improper treatment can result in several morbidities, including visual loss. Despite serious consequences, management for RH is not well established. However, lateral canthotomy with cantholysis is generally recommended. Therefore, the objective of this study is to review the management for RH.
A retrospective study was performed at our tertiary hospital from 1979 to 2006 for patients with the ICD9 code for RH. The demographic information, comorbidities, presentation, management, follow-up period, and outcomes were evaluated. Data were analyzed.
22 patients were identified with 13 males and an average age of 46 (range: 11-80) years. The RH was broken into 3 categories (iatrogenic: 7, trauma: 10, spontaneous: 5). The most common symptom was diplopia followed by orbital pain. The average proptosis was 3 (range: 0.5-6) mm and the average pre-treatment and post-treatment tonometric pressures were 22.5 (range: 12-60) and 14.5 (range: 2-20) mm Hg respectively. Treatments were cantholysis (1), high dose steroid (2), intravenous and topical medication (2), and conservative management with observation (17). 78% of the patient’s visual acuity improved with these treatments. The average follow up was 5 years. Only 2 patients had severe permanent central visual function disturbance in spite of rapid reduction of intraorbital pressure. (Only 1 following FESS).
Traditionally lateral canthothomy with cantholysis is recommended for the treatment for RH. However in certain patients and settings, there may be an acceptable alternative option for the management of RH. The mechanism of visual loss following retrobulbar hemorrhage remains unclear. It may not be adequate to simply reduce intraorbital pressure.
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