hg

Others

Ward

Emergencies

RETROBULBAR HAEMORRHAGE

 

Signs and symptoms
•    Loss of red vision (use Ishihara plates in 'Tools' section)
•    Pain
•    Decreased visual acuity (use Snellen chart in 'Tools' section)
•    Tense eye
•    Proptosis
•    Reduced eye movement
•    Fixed and dilated pupil

 

Treatment
•    Sit patient up
•    Medical (buying time)
•    Surgical (definitive)

 

Medical
•    IV 20% mannitol IV rapid infusion 1.5 to 2 g/kg over 30 min
•    IV acetazolamide 500mg stat followed by 6 hourly doses up 1000 mgs in 24 hours
•    IV hydrocortisone 100-200mg

 

Surgery
•    Lateral canthotomy
•    Inferior cantholysis

 

Equipment needed
•    Local anaesthetic
•    Toothed forceps
•    Straight iris scissors

 

Preparation
•    Chlorhexidine
•    Local anesthesic eg 2% lidocaine to the lateral canthal region

 

Lateral canthotomy
•    Use forceps to pull out the lower eyelid
•    Use iris scissors to incise the skin and orbicularis muscle at the lateral canthal angle in a horizontal direction extending to 10 mm

 
Figure 1: Lateral canthotomy

 

Inferior cantholysis
•    Use the forceps to pull the lateral lower eyelid away from the globe
•    Point the tips of the scissors inferolaterally away from the globe and cut the inferior crus of the lateral canthal ligament
•    The inferior crus, felt as a thick fibrous band suspending the lateral lower eyelid to the orbital rim, was incised near its insertion into the orbital rim


Figure 2: Inferior cantholysis

 

Author: Johno Breeze
Last updated: 15/02/15