Authors: Georges B. Nassrallah, Matthew Kondoff, Michael Ross, Jean Deschênes

Author Disclosure Block: G. Nassrallah: None. M. Kondoff: None. M. Ross: None. J. Deschênes: None.

Abstract Body:

Purpose: Retrobulbar hemorrhage (RBH) has been reported to be a rare, potentially sight-threatening complication causing orbital compartment syndrome (OCS) in orbital fractures. RBH causing OCS is regarded as a clinical diagnosis when evidence of optic nerve compression is found. Nonetheless, many patients with facial trauma will have received imaging by computed tomography (CT) on which there is documented retrobulbar hematoma, with or without signs of OCS. The aim of this study was to identify the incidence and describe the outcomes of these CT-diagnosed retrobulbar hematomas.
Study Design: This is a retrospective observational cohort study of patients with orbital fractures and CT-diagnosed retrobulbar hematomas.
Methods: Patients with orbital fractures for which ophthalmology was consulted were included in the study. Confirmation of orbital fracture and dictated presence of a retrobulbar hematoma on facial-bones CT was recorded. Patient demographics, proptosis, visual acuity, intraocular pressure and interventions received at initial visit and follow-up were recorded.
Results: 292 orbits with wall fractures were identified. 94 (32.2%) were documented by CT report to have a retrobulbar hematoma. Of these orbits, only one (1.1%) was diagnosed with OCS receiving canthotomy and cantholysis. 53 orbits with initial CT-diagnosed retrobulbar hematoma were seen in follow-up a week or more later, none of which had developed signs of OCS or needed medical or surgical intervention for OCS.
Conclusions: Retrobulbar hematoma is a frequently reported finding on CT in cases of orbital fractures. However, the vast majority of these do not develop OCS initially or later. CT presence of retrobulbar hematoma is a non-specific finding and should not guide diagnosis and treatment of OCS.