Abstract
Purpose :
Retrobulbar hemorrhage (RBH) is an ophthalmic emergency that can result in orbital compartment syndrome (OCS) with irreversible vision loss. OCS is a clinical diagnosis incorporating findings of a tense orbit, elevated intraocular pressure, and pupillary dysfunction. The purpose of this study is to identify indications for intervention in patients who underwent lateral canthotomy and cantholysis for treatment of retrobulbar hemorrhage.
Methods :
A retrospective chart review of adult and pediatric patients presenting with RBH at a Level 1 Trauma Center.
Results :
Two hundred and ninety-two adult and pediatric patients with RBH were identified from 2007 to 2017. All cases occurred after trauma and 103 patients underwent intervention with lateral canthotomy and cantholysis (C/C). The most common mechanism was assault (34%), followed by motor vehicle collision (19%). Initial visual acuity (VA) was not obtainable in 55 patients, the majority due to intubation or altered mental status. Notable exam findings included afferent pupillary defect (APD) in 42 patients (39%), proptosis in 56 patients (52%), and resistance to retropulsion in 41 patients (38%). These characteristics reached statistical significance when comparing the C/C group to those untreated. Restriction of ocular motility was noted in 39 patients (36%), however this was not statistically different between the two groups. The average initial intraocular pressure (IOP) was 43.0 mmHg (Range: 23-90 mmHg), with 38 patients (41%) having IOP less than 40 mmHg (Figure). IOP was decreased to 21.5 mmHg on average after intervention. The average logMAR VA improved from 1.29 to 0.88 (p=0.01) after lateral canthotomy and cantholysis.
Conclusions :
Many patients presenting with RBH have sustained serious bodily injury with factors precluding examination of VA, such as intubation or altered mental status. Although the most sensitive objective exam finding in our study that prompted intervention is the presence of an APD, this may be difficult to assess in patients with bilateral injuries and in patients with narcotic-induced miosis. OCS may occur with a lower IOP than previously expected, ranging from 23-90 mmHg in this study. Early recognition and prompt intervention of RBH allows for improved chance of visual recovery.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.