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Nurul Shaliza Shamsudin

Abstract

Traumatic retrobulbar haemorrhage (RBH) after blunt facial trauma is a rare but vision-threatening emergency (1, 2). Bleeding into retrobulbar space can create a compartment ocular syndrome (OCS), which led to permanent visual loss (3). Therefore, prompt recognition and appropriate treatment within a limited time is imperative in order to prevent these consequences. We present a case of a 48-year-old male patient with acute traumatic RBH complicated with non-compressive optic neuropathy after a blunt facial trauma. He presented with decreased visual acuity, proptosis and limited extraocular motility in the affected eye. Axial and coronal views of computed tomography (CT) of the orbit revealed left orbital and multiple maxillofacial bone fractures with retrobulbar haemorrhage. The left optic nerve and the rest of the extra-ocular muscles are preserved.  He was treated with high dose corticosteroids, however the vision ultimately lost. Recognizing, evaluating and managing vision-threatening injuries are paramount to reduce complications and risk of vision disability. Whenever possible, in cases of suspected traumatic RBH, rapid emergent referral to an ophthalmologist is required, whether or not definitive surgical intervention is performed.

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Keywords

Retrobulbar haemorrhage, traumatic optic neuropathy, orbital fracture, maxillofacial injuries, proptosis

References
1. Ballard SR, Enzenauer RW, O'Donnell T, Fleming JC, Risk G, Waite AN. Emergency lateral canthotomy and cantholysis: a simple procedure to preserve vision from sight threatening orbital hemorrhage. J Spec Oper Med. Summer 2009; 9(3):26-32.
2. Romaniuk VM. Ocular trauma and other catastrophes. Emerg Med Clin North Am. 2013 May; 31(2):399-411.
3. Perry M, Dancey A, Mireskandari K, et al: Emergency care in facial trauma—a maxillofacial and ophthalmic perspective. Injury 36. (8): 875-896.2005
Section
EMAS Meeting 2018 Abtracts