Retrobulbar hemorrhage with occult globe rupture – A sinister confluence

Abstract

Orbital compartment syndrome following blunt trauma is typified by an acute onset of proptosis and tight orbit, with retrobulbar hemorrhage (RBH) being the principal cause. A 9-year-old boy with blunt trauma to the left eye presented with sudden onset of pain and dramatic visual loss. Visual acuity was documented as perception of light. Examination revealed ecchymosis of eyelids, hemorrhagic chemosis, complete restriction of extraocular movements, exposure keratopathy, and relative afferent pupillary defect. A hazy view of the fundus revealed a normal optic disc. Although features favored RBH, the absence of “tight orbit” invoked suspicion. Computed tomography unveiled a hematoma in the superonasal aspect of the orbit with tenting of posterior aspect of the globe and altered globe contour, suggesting posterior globe rupture. This case highlights that an occult globe rupture should be suspected in traumatic proptosis with a “not so tight” orbit.