Retrobulbar hemorrhage during strabismus surgery

Abstract

PurposeThis case report presents an event of retrobulbar hemorrhage (RH) occurring during the initial stage of strabismus surgery after incision of the conjunctiva and Tenon's capsule. ObservationSignificant bleeding with subsequent proptosis was observed intraoperatively after the incision of conjunctiva and Tenon's capsule during routine strabismus surgery on the medial rectus muscle in a 5-year-old boy. Intravenous mannitol was administered intraoperatively and surgery was completed as planned. The RH receded within 24 hours without the necessity of orbital decompression. Tenon's capsule prolapse was noted on the first postoperative day and managed with surgical excision under shallow intravenous anesthesia. No damage to the optic nerve or ganglion cells was detected a week after and three months post-surgery. Conclusions and importanceStrabismus surgery bears a risk of RH at every stage of the operation. Careful hemostasis should be provided at each step of the procedure to decrease the risk of such an event. Patients after events of serious intraoperative bleeding should undergo careful post-operative investigation towards coagulation insufficiencies, though no such deficits were identified in the present case.