Visual diagnosis in emergency medicine: retrobulbar haemorrhage

An elderly patient on Coumadin presented to the emergency department one day after left eye surgery. She complained of orbital pain and vision loss. On examination there was eyelid ecchymoses, chemosis and proptosis (figure 1). There was complete vision loss with preservation of light sense. The patient went to the operating room for emergent decompressive surgery. She regained full vision in her eye. Diagnosis: retrobulbar haemorrhage Retrobulbar haemorrhage is a vision-threatening emergency. It is typically secondary to facial trauma or a surgical procedure. Without prompt recognition and treatment, the haemorrhage can expand and produce an orbital compartment syndrome. In orbital compartment syndrome, high intraocular pressure (IOP) damages the optic nerve and compromises vascular flow, resulting in retinal ischaemia.1 Total vascular insufficiency of only 60–120 min can produce permanent vision loss.2 Signs and symptoms indicative of high IOP may include painful proptosis, a difference...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: Eye Diseases, Cranial nerves, Pain (neurology), Radiology, Clinical diagnostic tests, Radiology (diagnostics), Ethics Images in emergency medicine Source Type: research