Retrobulbar Haematoma - A Complication That May Impair Vision

Retrobulbar haematoma (RBH) is a rare complication that may affect vision after a trauma or a surgical procedure. The diagnosis must be made promptly, as only early surgical intervention can adequately prevent irreversible visual impairment. Because of the bony orbital walls, there is hardly any room for the increasing intraorbital volume due to the retrobulbar haemorrhage. This leads to an increase in intraorbital pressure and subsequently to compression of the optic nerve. Symptoms include disorders in ocular motility, ophthalmoplegia, diplopia, conjunctival chemosis, subconjunctival haemorrhage, proptosis, increased intraocular pressure, deterioration in visual acuity, decreased direct pupillary reflex, and a relative afferent pupillary defect. If the cause is traumatic or iatrogenic, prompt lateral canthotomy with cantholysis is the treatment of choice, and successfully lowers pressure in most cases. It can be performed in the emergency room by an ophthalmologist and may even be indicated without previous imaging. As the reconstruction of cantholysis is generally uncomplicated, we recommend performing the procedure when RBH is suspected. If canthotomy with cantholysis does not lead to adequate improvement, surgical orbital decompression must be performed. Supportive treatment should always include systemic steroids.