Management of orbital injury and expanding orbital haematoma

Abstract

Expanding orbital haematoma (or retrobulbar haemorrhage) is a rare, potentially sightthreatening complication which results from trauma to one of the orbital arteries – namely, the branches of the ophthalmic artery (anterior and posterior ethmoidal arteries) or orbital vein. Such an orbital injury can result from head trauma or can be iatrogenic (e.g. following injection into the orbit or surgery). Very rarely, it can occur spontaneously. Visual loss results either from central retinal artery occlusion, optic neuropathy from stretching of the optic nerve, or direct compression of the optic nerve venous drainage. As the haematoma expands within the confines of the bony orbit, the tense sheet of tissue that stretches across the anterior orbital opening – the orbital septum (Figures 5.1 and 5.2) – prevents the escape of blood. This leads to a rise in intraorbital pressure and visual loss. Prompt therapeutic intervention, including an emergency lateral canthotomy and cantholysis and/or orbital decompression, may restore vision.