Retrobulbar Hemorrhage, Optic Nerve Dysfunction

Definition

Retrobulbar hemorrhage is an uncommon, vision-threatening complication of the orbit that in some instances can lead to irreversible loss of vision. The loss of vision can be attributed to the development of orbital compartment syndrome with secondary ischemia, increased intraocular pressure, or direct compression of the optic nerve.

Epidemiology

One study reported 115 cases of nontraumatic orbital hemorrhage over a 24-year period (Sullivan and Wright 2000). Retrobulbar hemorrhage can affect any age, either gender, and any race depending on underlying etiology although trauma and surgery are common causes.

Clinical Features

The most common symptoms and signs of retrobulbar hemorrhage include ipsilateral orbital pain, pressure, ophthalmoplegia, proptosis, and loss of vision. Patients may complain of headache, diplopia, nausea, and vomiting (Lewis and Perry 2007). Signs of an acute retrobulbar hemorrhage are usually obvious and include a tense orbit, rapidly progressive...