Eye trauma: could you manage a retrobulbar haemorrhage?

 

Background

 

Patients with head injuries sometimes present with a closed, swollen eye. We rightly worry about intracranial bleeding in these cases, but there are some important eye injuries to consider too. Dr Anna MacDonald​[1]​ suggests that the following four time-critical, sight-threatening diagnoses should be foremost in our minds when assessing a patient with blunt ocular trauma...

 

  1. Retrobulbar haemorrhage with orbital compartment syndrome
  2. Globe rupture
  3. Retinal detachment
  4. High grade ('8-ball') hyphema with acute glaucoma

 

The first of these, retrobulbar haemorrhage (RBH), is a fairly rare condition and many of us will be unfamiliar with its features and recommended management. A recent paper in the EMJ tried to assess the competency of UK ED docs in treating RBH, and identified some issues...

 

The paper

 

Edmunds MR, Haridas AS, Morris DS, Jamalapuram K. Management of acute retrobulbar haemorrhage: a survey of non-ophthalmic emergency department physicians. Emerg Med J 2019;36(4):245-247 ​[2]​

 

 

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