Abstract
Retrobulbar haemorrhage (RBH) is a potentially blinding consequence of craniofacial
trauma, but timely ophthalmic evaluation is difficult to obtain in some settings and
clear standards for canthotomy/cantholysis are lacking. We have sought to develop
an algorithm to identify vision-threatening traumatic RBH that requires emergent decompression.
We retrospectively reviewed 42 consecutive consultations for RBH at a level-one trauma
centre. Charts and imaging studies were analysed with attention to mechanism of injury,
comorbid trauma, and ophthalmic findings. A total of 22 eyes were observed without
intervention, 13 were treated pharmacologically, and seven by emergent canthotomy/cantholysis.
No differences in standard trauma metrics were found among these groups. Lid oedema,
ecchymosis, chemosis, subconjunctival haemorrhage, and ocular motility also failed
to correlate with a need for surgical intervention. “Tight” eyelids (p < 0.001), unilateral proptosis (p < 0.001), and relative afferent pupillary defect (RAPD; p = 0.029), however, all related to a need for canthotomy/cantholysis (Fisher’s exact
test). Tenting of the globe, which was the only radiographic finding to predict the
need for surgery, was seen in just two of the seven cases that required decompression.
Many of the traditionally emphasised clinical signs therefore fail to identify cases
of RBH that require decompression. Our data support a simple three-factor decision
tool. These are: relative proptosis, eyelids that are difficult to open with finger
pressure, and presence of an RAPD in the traumatised eye. If all three are noted or
if the patient has proptosis and tight lids in the absence of a large preseptal haematoma,
he/she is likely to need surgical decompression. Tenting of the globe on computed
tomography (CT), while a relatively rare finding, should also alert the physician
of the need for intervention.
Keywords
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Article info
Publication history
Published online: June 13, 2020
Accepted:
May 19,
2020
Identification
Copyright
© 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
