Persistent visual loss following retrobulbar hemorrhage

Abstract

R etrobulbar anesthesia is considered both safe and effective by most ophthalmologists and anesthesiologists.1 However, retrobulbar hemorrhage, either arterial or venous, is one of the most devastating complications of local anesthesia, with an incidence of about 0.7% to 1.7%.2-6 Patients usually have sudden onset of proptosis, hemorrhagic chemosis, vision loss and pain. The rapid increase in intraorbital pressure due to the mechanical limitations within the bony orbit may also cause increased intraocular pressure (lOP). This elevated lOP may compromise ocular blood flow, resulting in permanent loss of vision if not recognized and treated early.7·8 The standard therapy for orbital compartment syndrome is immediate lateral canthotomy and cantholysis.3•9 If this is performed adequately and promptly, bleeding within the retrobulbar cavity should no longer be restricted, and the intraorbital pressure and lOP should decrease. We describe a patient with a retrobulbar hemorrhage who, despite adequately performed immediate canthotomy and cantholysis, continued to have progressive visual loss.