Like tension pneumothorax the biggest step is deciding to do it – Remember it it sight saving and they heal well

Retrobulbar Haematoma secondary to blunt eye injury is a a rare but potentially sight threatening injury.

• Blood collects in the retrobulbar space
• Pushing the eye forward to accommodate the extra volume.
• The Orbital Septum (made up of the eyelids and ligaments that attach them to the orbital rim) restricts this forward movement, creating a compartment syndrome for the eye. Thus threatening the patients sight if not treated quickly.

Recognition

From Royal College Ophthalmologists

• Severe pain
• Red/Congested conjunctiva
• Exophthalmos with proptosis – eye pushed forward
• Internal ophthalmoplegia – impairment or loss of the pupillary reflex.
• Visual flashes
• Loss of vision – initially colour vision (esp. red), progressing to local visual loss.

However, this may only be recognised on CT if there is significant facial injury and altered conscious level.

Treatment

Call Ophthalmology immediately to attend. If there is going to be any significant delay, it may be necessary for ED to preform a Lateral Canthotomy, to allow the eye to move forward, reduce the orbital pressure & preserve the patients sight.

Kit needed

• Lidocaine with adrenaline (needle & syringe)
• Clamp – ideally curved to crush the tissues
• Forceps
• Scissors

Resources

• Royal College of Ophthalmologists – Traumatic Orbital Emergencies
• Making a training model – Great article covering it HERE
  • Tips not in the paper
    • Creme Fraiche Pot – works (use 53mm paper tube to hold eye in place)
    • Cut square hole 34x34mm
    • Rubber band cut 40mm slit
    • Reinforce the Eyelid corners with foam so the rubber band doesn’t stick (i.e. small square facing down
    • When applying the foam eye lids ensure cants at the corners of the square