Summary
Background
Retrobulbar haematoma formation is a known complication following facial trauma involving
the orbits. This is an important clinical entity as it can lead to permanent vision
loss if not appropriately managed in the acute setting.
Methods
From 1999 to 2009, 2586 patients presented to the Chang Gung Memorial Hospital with
orbital fractures. Eight patients presented with nine retrobulbar haematomas. A retrospective
review of the patient's medical records was performed. Analysis of visual outcomes
was performed based on the improvement degree (ID) formula.
Results
The average age of our patients is 24.5 years with the most common cause of trauma
being motor vehicle (motorcycle) collisions. Visual acuity and the light reflex were
abnormal in all patients. Five patients (case #1–5) demonstrated an absent relative
afferent pupillary defect (RAPD). Computed tomography imaging confirmed the presence
of a retrobulbar haematoma in all patients. The average follow-up was 14.5 months
(range: 6–20 months). Management was divided into three cohorts: observation alone,
medical therapy alone or a combined surgical and medical therapy. The best visual
outcomes (ID = 82%) were achieved in the combined treatment group. The worst outcomes
(ID = 42%) were in the medical therapy alone group.
Conclusion
In review of our experience, we have found that the presence or absence of an RAPD
is the most sensitive indicator of optic nerve compromise and necessity for intervention.
An algorithm was also developed based on this study. Once a decision is made to intervene
on a retrobulbar haematoma, both medical and surgical therapies should be instituted
with a priority given to timely decompression of the orbit.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Late retrobulbar hemorrhage and blindness following malar fracture complicated by factor XI deficiency.J Oral Maxillofac Surg. 1993; 51: 699-702
- Blindness after reduction of facial fractures.Plast Reconstr Surg. 1999; 104: 875-876
- Blindness after reduction of facial fractures.Plast Reconstr Surg. 1998; 102: 1821-1834
- Delayed retrobulbar hematoma after blepharoplasty.Ophthal Plast Reconstr Surg. 2001; 17: 126-130
- Blindness and intranasal endoscopic ethmoidectomy: prevention and management.Otolaryngol Head Neck Surg. 1989; 101: 320-329
- Lateral canthotomy: a simple and safe procedure for orbital haemorrhage secondary to endoscopic sinus surgery.Rhinology. 1998; 36: 37-39
- Complications of endonasal paranasal sinus surgery-diagnostic and therapeutic consequences.Laryngorhinootologie. 1998; 77: 402-409
- Complications of regional anaesthesia incidence and prevention.Drug Saf. 2001; 24: 413-442
- Visual loss following dacryocystectomy.Ophthalmic Surg Lasers Imaging. 2006; 37: 494-496
- Treatment of retrobulbar hematoma in accident and emergency departments.Br J Oral Maxillofac Surg. 1996; 34: 289-292
- Nasi. Diagnosis and treatment of retrobulbar hematomas following blunt orbital trauma: a description of eight cases.Int J Oral Maxillofac Surg. 2005; 34: 127-131
- Pterional orbita decompression in orbital hemorrhage and trauma.J Trauma. 2002; 53: 73-78
- Acute retrobulbar hemorrhage during elective blepharoplasty.Plast Reconstr Surg. 1973; 52: 8-15
- Blidness after blepharoplasty: mechanism and early reveals.Plast Reconstr Surg. 1978; 61: 347-354
- Central retinal artery occlusion and retinal tolerance.Ophthalmology. 1980; 87: 75-78
- The use of mannitol in intraocular surgery.Ophthalmic Surg. 1983; 14: 55-56
- Bilateral visual loss after blepharoplasty.Ann Plast Surg. 1980; 5: 288-292
- Sudden blindness following facial trauma.Otolaryngol Head Neck Surg. 1981; 89: 941-948
- Management of traumatic optic neuropathy – a study of 23 patients.Br J Ophthalmol. 1992; 76: 349-352
- Orbital hemorrhage with loss of vision.Am J Ophthalmol. 1980; 89: 593-597
- A simplified technique of orbital decompression for severe retrobulbar hemorrhage.Am J Ophthalmol. 1993; 116: 34-37
- Postoperative retrobulbar hemorrhage and blindness complicating trauma surgery.Br J Oral Surg. 1981; 19: 202-207
- Decompression of the orbit and the optic nerve in different diseases.J Craniomaxillofacial Surg. 1988; 16: 308-311
- Visual recovery following immediate decompression of traumatic retrobulbar hemorrhage via transcranial approach.Neurol Med Chir. 1998; 38: 221-224
- Predictive value of the initial quantified relative afferent pupillary defect in 19 consecutive patients with traumatic optic neuropathy.Ophthalmic Plast Reconstr Surg. 2001; 17: 323-327
- Lateral canthotomy and inferior cantholysis: an effective method of urgent orbital decompression for sight threatening acute retrobulbar hematoma.Injury. 1999; 34: 485-490
Article info
Publication history
Published online: June 21, 2012
Accepted:
April 26,
2012
Received:
January 12,
2012
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
