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Ophthalmology

Retrobulbar Hematoma

Retrobulbar hematoma is the phenomenon of blood collecting in the retrobulbar space behind the globe. Although not common, it is a serious condition that can lead to blindness. This activity reviews the evaluation and management of retrobulbar hematoma and highlights the role of the interprofessional team in improving care for patients with this condition. Objectives: Determine the etiology of retrobulbar hematoma. Identify the pathophysiology of retrobulbar hematoma. Assess the typical presenta

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Although not common, it is a serious condition that can lead to blindness.
  • a devastating consequence is orbital compartment syndrome, which can potentially lead to complete vision loss if not treated promptly.
  • If a patient displays the signs and symptoms typical of optic nerve ischemia from RBH, however, radiographic imaging should be delayed in favor of prompt surgical intervention.
  • the attending physician should not delay definitive management if optic nerve ischemia is suspected and intraocular pressure is greater than or equal to 40 mmHg.
  • The development of a retrobulbar hematoma is most commonly associated with trauma, especially orbital floor fractures.
  • Patients may complain of diplopia, headache, nausea, and vomiting.
  • Some common signs and symptoms are eye pain, periorbital ecchymosis, decreased visual acuity, elevated IOP, a tense and progressive proptosis, ophthalmoplegia, and optic disc swelling.
  • Intraocular pressure is an essential part of the physical exam.
  • elevated IOP (normal range between 8 and 21 mmHg) and proptosis correlate well with orbital compartment pressure and are sufficient to indicate an impending orbital compartment syndrome.
  • Although radiographic testing can help to confirm a retrobulbar hematoma, the diagnosis is clinical.
  • CT imaging can help visualize the extent of the hematoma and identify other associated injuries such as maxillofacial fractures, globe rupture, or intraocular foreign bodies.
  • Once the diagnosis of a retrobulbar hematoma is confirmed, ophthalmology should be emergently consulted.
  • Adequate anesthesia and antiemetics should be provided to aid in patient comfort and help prevent Valsalva maneuvers such as vomiting.
  • A vital part of management is immediate orbital decompression with lateral orbital canthotomy and cantholysis (LOCC).
  • Mild cases of RBH without signs or symptoms of optic nerve compromise should be managed by observation or medical treatment.
  • Patients with RBH and no symptoms or elevated IOP can be monitored without intervention.
  • Alternative methods described in the literature for mild to moderate cases are direct needle aspiration of the hematoma and topical, oral, or intravenous medications such as beta-blockers (timolol maleate), steroids, and osmotic agents (mannitol).
  • Acetazolamide is another well-studied drug that can be administered orally or intravenously to lower IOP successfully.
  • Steroids may also protect against traumatic optic neuropathy.
  • In cases of postoperative RBH, prevention may be an effective form of management.
  • informing patients to stop non-essential anticoagulants before surgical repair may be advisable.
  • IOP should be reassessed approximately 6 hours after the initial evaluation to ensure that there is no interim elevation that could signify a possible rebleed and indicate intervention.
  • For all cases, appropriate follow-up with ophthalmology should be established.
  • The frequency of monitoring depends on the patient’s severity of RBH.
  • Complications of LOCC include a persistently elevated IOP, which may indicate inadequate cantholysis.
  • Other complications from performing a lateral orbital canthotomy include damage to nearby ocular structures, globe rupture, infection, bleeding, and eyelid malpositioning.
  • After a complete LOCC, visual acuity, IOP, pupillary function, and other signs of optic nerve ischemia should be reassessed.
  • The surgical site should also be monitored at appropriate intervals for signs of infection.
  • review
    Retrobulbar Hematoma. StatPearls [Internet] — Shaina Kumar, Nancy Blace — StatPearls Publishing, 2022

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov