Retrobulbar haemorrhage

• A retrobulbar haemorrhage may occur following eyelid surgery or ocular trauma. This can rapidly increase the pressure within the orbit, causing compressive ischaemia to the optic nerve. This is termed orbital compartment syndrome (OCS) and is a true ophthalmic emergency. 
• Symptoms:

  • Proptosis
  • Significant resistance to eye movement
  • Eyelids may be very tense and difficult to open
  • Restriction in extraocular muscle movement
• On exam:

  • Diminished visual acuity
  • Relative afferent pupillary defect
  • Reduced colour vision
• A CT orbit will demonstrate retrobulbar haemorrhage and associated injuries, but this should be deferred if there are any signs of orbital compartment syndrome
• Orbital compartment syndrome requires immediate decompression via lateral canthotomy