Delayed-type retrobulbar hematoma caused by low temperature after reconstruction of inferior blow-out fracture

Abstract

Retrobulbar hemorrhage is a disastrous condition that can lead to permanent blindness. As such, rapid diagnosis and treatment are critical. Here, we report a patient who presented with retrobulbar hemorrhage following an orbital floor fracture. Restoration of inferior orbital wall with porous polyethylene implant was underwent. Four days after the orbital floor reconstruction, the patient smoked a cigarette outdoors in -3˚C weather. Cold temperature and smoking caused an increase in his systemic blood pressure. The elevated blood pressure increased intraorbital pressure to the extent of causing central retinal artery occlusion and exacerbated oozing. During exploratory surgery, 3 mL of hematoma and diffuse oozing without arterial bleeding were observed. Prompt diagnosis and treatment prevented vision impairment. Few studies have reported on the risk factors for retrobulbar hemorrhage. This case showed that daily activities, such as exposure to cold weather or tobacco smoking, could be risk factors for retrobulbar hemorrhage.

Orbital floor fracture repair with implants: a retrospective study

“…The forced duction test was performed after implant placement to ensure eye mobility [ 3 ]. Negative pressure drainage systems were not applied, although they are known to be effective for retrobulbar hemorrhage prevention [ 4 ]. In the absence of contraindications, an intravenous injection of 62.5 mg of methylprednisolone was administered once preoperatively and once daily for 2 days postoperatively to control the swelling [ 5 ].…”

Ambulatory Orbital Fracture Repair: An Analysis of ER Visits After Surgery From a Multistate Study

“…A survey among North American craniomaxillofacial faculty revealed that monitoring for signs and symptoms concerning RBH was the primary reason for admitting patients postoperatively 3 . However, most studies, like ours, have identified either no case or very low rates of RBH, typically <1% 14‐18 . In these studies, the timing of RBH ranged from the immediate postoperative period in the postanesthesia care unit (PACU) to the delayed period of up to 7 days after surgery.…”

“…3 However, most studies, like ours, have identified either no case or very low rates of RBH, typically <1%. [14][15][16][17][18] In these studies, the timing of RBH ranged from the immediate postoperative period in the postanesthesia care unit (PACU) to the delayed period of up to 7 days after surgery. A systematic review and meta-analysis found that the onset of RBH was on average 29.8 hours after surgery.…”