Retrobulbar Haemorrhage

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Retrobulbar haemorrhage is a rare but serious condition characterised by bleeding within the orbit (the bony cavity that contains the eye), which can lead to increased intraorbital pressure and potential vision loss.

Aetiology

Retrobulbar haemorrhage can result from various causes, including:

• Orbital trauma (e.g., blunt or penetrating injuries)
• Surgical procedures (e.g., orbital or sinus surgery)
• Anticoagulant or antiplatelet therapy
• Spontaneous bleeding in patients with bleeding disorders
• Vascular malformations

Pathophysiology

Bleeding within the orbit leads to the accumulation of blood behind the eyeball (retrobulbar space), causing increased intraorbital pressure. This pressure can compress the optic nerve and retinal vessels, leading to ischaemia and potential vision loss. The condition requires immediate intervention to prevent permanent damage.

Risk Factors

• Orbital or facial trauma
• Recent orbital or sinus surgery
• Use of anticoagulant or antiplatelet medications
• Bleeding disorders (e.g., haemophilia, von Willebrand disease)
• Vascular abnormalities in the orbit

Signs and Symptoms

Common signs and symptoms of retrobulbar haemorrhage include:

• Severe eye pain
• Proptosis (bulging of the eye)
• Restricted eye movements (ophthalmoplegia)
• Decreased visual acuity
• Ecchymosis (bruising) around the eye
• Increased intraocular pressure

Investigations

• Clinical history and physical examination
• Measurement of intraocular pressure (tonometry)
• Ophthalmoscopy to assess the optic nerve head
• Imaging studies:
  • CT scan of the orbits to evaluate the extent of haemorrhage and orbital anatomy
  • MRI if further detail is needed or if there is concern about other orbital pathology
• Blood tests to check for coagulation abnormalities

Management

Primary Care Management

• Immediate referral to an ophthalmologist or emergency department: Retrobulbar haemorrhage is an ocular emergency

Specialist Management

• Surgical intervention:
  • Lateral canthotomy and cantholysis: A surgical procedure to relieve intraorbital pressure by creating an incision in the lateral canthus of the eye
  • Orbital decompression: In severe cases, surgical removal of some orbital bones to reduce pressure
• Management of underlying conditions: Addressing bleeding disorders or adjusting anticoagulant therapy
• Regular follow-up to monitor recovery and manage any complications

References

1. NICE. (2024). Retrobulbar Haemorrhage: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Retrobulbar Haemorrhage. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Retrobulbar Haemorrhage: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Ophthalmology (AAO). (2021). Clinical Practice Guidelines: Retrobulbar Haemorrhage. Retrieved from AAO

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