Incidence and management of retrobulbar hemorrhage after blowout fracture repair

Abstract

Background Retrobulbar hemorrhage (RBH) is a rare complication after orbital surgery but associated with ocular complications including blindness. The aim of this study was to identify clinical characteristics of patients with RBH requiring emergent orbital decompression after blowout fracture repair. Method A retrospective review of 426 blowout fracture patients at a tertiary oculoplastic clinic provided data regarding demographics, physical examination findings, and computed tomography (CT) images. Extraocular motility had been recorded in patient charts on a scale from 0 to − 4. Patients requiring emergent orbital decompression due to RBH after surgery (RBH group) were compared with those who did not (Control group), using the Mann-Whitney U-test. Incidences of RBH according to primary or secondary surgery were also investigated, using Fisher’s exact test. Result Five (1.2%) of the 426 patients who underwent blowout fracture repair developed RBH requiring emergent intervention. All RBH patients fully recovered after the decompression procedure or conservative treatment. Number of days to surgery was significantly longer in the RBH group (97.0 ± 80.1) than in the Control group (29.0 ± 253.0) (p = 0.05). Preoperative enophthalmos was also significantly greater in the RBH group (RBH vs. Control group, 3.6 ± 1.7 mm versus 1.2 ± 1.3 mm (p = 0.003)). The incidence of RBH was significantly higher in patients that underwent secondary surgery (odds ratio = 92.9 [95% confidence interval, 11.16–773.23], p = 0.001). Conclusions Surgeons should pay more attention to hemostasis and postoperative care in patients with a large preoperative enophthalmic eye, when time from injury to surgery is long and in revision cases. When RBH occurs, time to intervention and surgical decompression is critical for visual recovery and preventing blindness. Trial registration The institutional review board of the Yeungnam University Medical Center approved this study (YUMC 2018-11-010), which was conducted in accord with the Declaration of Helsinki.

Retrobulbar Hematoma after an open reduction of blow-out fracture of orbit

“…5 Among the complications and possible consequences that this type of fracture can present is the retrobulbar hematoma, which, although it has a low incidence, requires important care since it can lead to people who present it ending up with visual alterations and even with irreversible blindness due to optic nerve ischemia, retinal necrosis and retinal artery vasospasm due to increased intraocular pressure (IOP). 6,14,15 When a retrobulbar hematoma occurs, people may experience ocular symptoms such as circumbulbar pain and pressure, proptosis, eyelid discoloration, mydriasis, visual impairment, and diplopia. Similarly, symptoms of increased IOP such as nausea, vomiting and headache may occur.…”

Ophthalmologic Emergencies

“…Proptosis, resulting from blunt force trauma, suggests a retrobulbar hemorrhage or orbital compartment syndrome. Management of this condition requires an emergent lateral canthectomy to prevent blindness (Park et al, 2021). Orbital compartment syndrome may also entrap the eye muscles causing abnormal extraocular movements.…”