Visual recovery following emergent orbital decompression in traumatic retrobulbar haemorrhage

Kelvin Y C Lee, Sharon Tow, Kee-Siew Fong
Annals of the Academy of Medicine, Singapore 2006, 35 (11): 831-2

INTRODUCTION: Acute retrobulbar haemorrhage is a potentially sight-threatening condition, and can follow retrobulbar anaesthesia or trauma to the orbit. Acute loss of vision can occur with retrobulbar haemorrhage and is reversible if the condition is recognised and treated early.

CLINICAL PICTURE: We report a case of acute retrobulbar haemorrhage following orbital trauma in a 78-year-old Chinese lady.

TREATMENT: The patient was on follow-up for a mature cataract in the right eye and had been scheduled for cataract surgery. The patient presented to the emergency department with acute loss of vision in the right eye, severe proptosis and tense periorbital haematoma after she hit her right face following a fall. Computed tomography scans revealed fractures of the floor, lateral and medial walls of the right orbit as well as retrobulbar and periorbital haematoma. There was marked proptosis and tenting of the globe with stretching of the optic nerve. Emergent lateral canthotomy and cantholysis was performed at the emergency department. The patient subsequently underwent surgical evacuation of the orbital haematoma.

OUTCOME: The patient's vision in the right eye recovered from no perception of light to light perception over the next few days. After a month of follow-up, the patient underwent right cataract surgery, and her best corrected visual acuity was 6/12 part.

CONCLUSION: In severe acute retrobulbar haemorrhage, prompt surgical evacuation of the haematoma can reverse visual loss.

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