Retrobulbar Hematoma in a Patient with Thyroid Eye Disease

Authors

Christina Y Weng

Publication Date

1-1-2022

Journal

Journal of Emergencies, Trauma, and Shock

DOI

10.4103/jets.jets_164_21

PMID

36643769

PMCID

PMC9838644

PubMedCentral® Posted Date

12-7-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Proptosis, retrobulbar hematoma, retrobulbar hemorrhage, thyroid eye disease, trauma

Abstract

A 37-year-old female with a history of thyroid eye disease presented after trauma to the right side of her face. Visual acuity was light perception and a relative afferent pupillary defect was detected. There was gross proptosis of the unruptured right globe with diffuse conjunctival hemorrhage. Computed tomography revealed an intraconal retrobulbar hematoma (RBH) with anterior herniation of the globe. The extraocular muscles were thickened, consistent with her thyroid eye disease, and her superior rectus was avulsed. The optic nerve was on stretch, but there was no evidence of transection. The patient ultimately underwent enucleation with the plan for an eventual ocular prosthesis. In RBH, blood accumulates in the retrobulbar space and can lead to an increase in intraocular pressure, optic nerve stretch, or mechanical blockage of ocular perfusion. A brief review of RBH is included to emphasize the most important aspects of diagnosis and management of this vision-threatening emergency.