Ver el código de «Retrobulbar hemorrhage»

==Background==
*Also known as retrobulbar hematoma
*Most often due to [[blunt orbital trauma]]
**Can also be secondary to spontaneous bleeding<ref name="RBHTA" />
*Can cause loss of vision within 60-120 min due to abrupt increase in intraocular pressure → orbital compartment syndrome (OCS)

==Clinical Features==
[[File:PMC3700149 NJMS-3-152-g008.png|thumb|Retrobulbar hemorrhage]]
*[[Eye pain]]
*[[Proptosis]]
*[[Visual loss|Decreased visual acuity]]
*Elevated [[IOP]] 
**(Do not perform tonometry if globe rupture is suspected)

==Differential Diagnosis==
{{Maxillofacial trauma DDX}}

{{Periorbital swelling DDX}}

==Evaluation==
[[File:PMC2908661 wjem-11-208f2.png|thumb|Computed tomography demonstrating left retrobulbar hemorrhage with proptosis.]]
*CT Orbit
*[[Ocular ultrasound]]<ref>Blaivas M, Theodoro D, Sierzenski PR. A study of bedside ocular ultrasonography in the emergency department. Acad Emerg Med. 2002 Aug;9(8):791-9.</ref><ref>Kilker BA, Holst JM, Hoffmann B. Bedside ocular ultrasound in the emergency department. Eur J Emerg Med. 2014 Aug;21(4):246-53.</ref><ref>Estevez A, Deutch J, Sturmann K, et al. Ultrasonography evaluation of retrobulbar hematoma in bovine orbits. Acad Emerg Med. 2000 Oct;7(10):1169-70.</ref>
**Diagnosis of retrobulbar pathology via ultrasound is technically difficult, has not been validated in the clinical setting and false-negatives have been reported<ref name="RBHTA">Thompson D, Stanescu C, Pryor P, Laselle B. Retrobulbar Hematoma from Warfarin Toxicity and the Limitations of Bedside Ocular Sonography. Western Journal of Emergency Medicine. 2010;11(2):208-210.</ref> - therefore, CT should remain the standard diagnostic tool for suspected retrobulbar pathology.

==Management==
*Consider [[lateral canthotomy]] and cantholysis, if indicated
*Emergent ophthalmology consultation
*Consider medical management in conjunction with cantholysis
**20% [[mannitol]] 2 g/kg IV
**[[methylprednisolone]], 250mg IV or hydrocortisone 100mg IV
**[[acetazolamide]], 250 to 500mg IV

==Disposition==
*Admit

==See Also==
*[[Ocular compartment syndrome]]
*[[Orbital Blowout Fracture]]
*[[Canthotomy]]
*[[Eye Algorithm (Main)]]
*[[Blunt Eye Trauma]]

==References==
<references/>

[[Category:Ophthalmology]]