Corneacare Logo
  • CorneaCare Logo
  • Shop
    • Shop All
    • Eyelid Hygiene
    • Eye Vitamins
    • Eye Drops
    • Eyecare Bundles
  • Education
    • Dry Eye Disease
      • Dry Eye 101
      • Causes & Diagnosis
      • Lifestyle
      • Treatment
      • Why It Matters
    • Eye Health & Wellness
    • Eye Glossary
    • Take the Quiz
  • Community
  • App
  • Take the Quiz
  • Contact us
  • Login
  • My Account
Login
Cart Icon 0
Take the Quiz
  • Shop
  • Education
  • Our App
  • Take the Quiz
  • Shop
  • Education
  • Our App
  • Take the Quiz

A-Z Glossary

Table of Contents

Retrobulbar Hemorrhage

Vasudha Rao
Written byVasudha Rao
Vasudha Rao
Vasudha Rao4th Year Optometry Student, UC BerkeleyBerkeley, CA

Bio

Vasudha Rao is a fourth-year optometry student at the UC Berkeley School of Optometry with aspirations of specializing in ocular disease or community care. She is currently on clinical rotations. She enjoyed serving veterans at the Miami Veterans Affairs Hospital and learning from renowned clinicians at the Bascom Palmer Eye Institute as a part of her clinical training. Vasudha is passionate about helping underserved communities receive optometric care, and actively volunteers to provide vision screenings to those in need. In her spare time she enjoys partaking in a game of Scrabble, enhancing her cooking skills, and sharing her clinical cases on her Instagram page @visions.of.vasudha.

  • Last updated November 3, 2022

What Is Retrobulbar Hemorrhage?

Retrobulbar hemorrhage is bleeding within the bony orbital cavity, behind the eyeball. Retrobulbar hemorrhage is a rare but sight-threatening condition that needs prompt medical intervention. Symptoms of retrobulbar hemorrhage include severe pain, inability to open the eyes, and vision loss. If untreated, retrobulbar hemorrhage can damage the optic nerve and blood vessels in the retina and lead to blindness. Common causes of retrobulbar hemorrhage are traumatic injury to the orbit and orbital surgery. Depending on the severity of the retrobulbar hemorrhage, surgery may be required.

Key Takeaways

  • Retrobulbar hemorrhage is a condition in which blood accumulates in the orbital cavity, the space behind the eyeball.
  • Retrobulbar hemorrhage is usually caused by a blunt force injury to the eye, but may also be a consequence of orbital surgery.
  • Depending on the severity of the retrobulbar hemorrhage, surgery may be required.
You brush your teeth,
moisturize your skin,
what about your eyes?
Take the quiz
Eyecare Quiz on Cellphone

Understanding Retrobulbar Hemorrhage

The eyeball, also called the globe of the eye, is contained in a bony structure called the orbit. The orbit is a deep depression in the skull that stores the eyeball. It is an empty cavity that is also known as the eye socket. The retrobulbar space is in the orbit, behind the eyeball.  The orbital compartment is made up of four walls, which are formed by the cranial bones. The walls of the orbit are the roof, the floor, the lateral wall (close to the ear), and the medial wall (close to the nose). If the walls of the orbit are damaged or broken, blood can seep into the retrobulbar space. This pooling of blood is called a retrobulbar hemorrhage. A retrobulbar hemorrhage can cause many problems such as elevated eye pressure and decreased blood supply to the eye.

Pathophysiology

Bleeding in the retrobulbar space usually occurs due to blunt force trauma, such as being punched in the eye. Blunt force injury causes the orbital walls to fracture or break. When the orbital walls fracture, blood can seep in through the cracks and enter the retrobulbar space. The accumulation of blood in the retrobulbar space pushes on the eyeball and increases the eye pressure. The acute rise of orbital pressure is called orbital compartment syndrome, and it is an ophthalmic emergency that requires urgent treatment to avoid complete vision loss. When the orbital pressure becomes high, it stretches and damages the optic nerve. The central retinal artery, which supplies blood to the retina, also becomes compressed when the orbital pressure is high. The compression of the central retinal artery causes a central retinal artery occlusion, and the retina becomes devoid of blood supply. Lack of blood supply (ischemia) can injure most of the retinal cells within 90 minutes of the artery compression. Thus, people who have blunt trauma to the eye with suspected orbital compartment syndrome and retrobulbar hemorrhage should visit the emergency room or ophthalmologist immediately to have the best chances of visual recovery.

Etiology

Most commonly, retrobulbar hemorrhage occurs due to traumatic injuries, especially orbital floor fractures. However, it can be associated with recent eye surgery. It may also be associated with conditions that affect the blood supply to the eyes such as arteriovenous malformations, orbital varicosities, or lymphangiomas.

High blood pressure and the use of anticoagulant medications such as NSAIDs, warfarin, or aspirin increase the risk of retrobulbar hemorrhage and compartment syndrome. Blood clotting disorders also increase the risk.

Diagnosis

The diagnosis for the condition is mainly clinical and involves the ophthalmologist doing a detailed examination of the external and internal structures of the eye. Radiological imaging, such as a CT scan or MRI are also helpful.

Symptoms of a retrobulbar hemorrhage are:

  • Rapid vision loss
  • Sudden, intense pain inside or behind the eye
  • Difficulty opening the eye
  • Eyelid swelling
  • The appearance of bulging eyes
  • Double vision

Signs the doctor may see during their clinical examination include:

  • Proptosis: The accumulation of blood in the space behind the eyeball displaces the eye forward, which can make the eyes appear bulging or popping out of the skull.
  • Decreased visual acuity
  • Afferent pupillary defect: improper pupillary response to light
  • Restricted eye muscle movement
  • Eyelid bruising
  • High intraocular pressure
  • Optic nerve and retinal pallor

Treatment/Management

Treatment depends on the extent of the retrobulbar hemorrhage and associated symptoms and exam findings. Small hemorrhage with good visual acuity and exam may be observed. However, if a patient has hemorrhage with orbital compartment syndrome, emergent surgery is needed. The orbital pressure can be decreased through a surgical procedure called canthotomy and cantholysis. During this surgery, the lateral part of the lower eyelid is cut with scissors. The goal of canthotomy and cantholysis is to cut the tendon attachments that hold up the eyeball. When the eyelid tendon is cut, the eyelid can move forward, and the increased space will decrease the orbital pressure behind the eye.

Bibliography

  1. Kumar, Shaina, and Nancy Blace. “Retrobulbar Hematoma.” PubMed, StatPearls Publishing, 2022, www.ncbi.nlm.nih.gov/books/NBK576417/. Accessed 4 Aug. 2022.
  2. “Orbital Compartment Syndrome – EyeWiki.” Eyewiki.org, eyewiki.org/Orbital_Compartment_Syndrome.
  3. “Retrobulbar Hemorrhage – EyeWiki.” Eyewiki.aao.org, eyewiki.aao.org/Retrobulbar_Hemorrhage. Accessed 4 Aug. 202

Related Terms

Loading...

Pupillometer

is a device that measures the distance between the pupils. The device is used when you order new eyeglasses

Oculus Sinister

is the Latin term that translates to “left eye”, often used to denote the left eye’s glasses prescription

Goldmann Visual Field

tests an individual’s complete field of vision

Emmetropia

is an eye with no refractive error (no prescription for nearsightedness, farsightedness or astigmatism)

Leber's Hereditary Optic Neuropathy (LHON)

is a rare, maternally inherited optic neuropathy and may lead to blindness

Epiretinal Membrane

is fibrous tissue (scar tissue) that forms on the top of the retina

Related Articles

Loading...
  • Eye Health & Wellness

Eye Bag Surgery Gone Wrong

7 min read

Understand the complications of eye bag surgery gone wrong and how it can damage the function and health of your eyes.
Heather Cottrell

Heather Cottrell

  • Eye Health & Wellness

Sharp Stabbing Pain in Eye that Comes and Goes

7 min read

Find out what’s causing that sharp stabbing pain in your eye that comes and goes. And when to see a doctor!
Heather Cottrell

Heather Cottrell

  • Eye Health & Wellness

A Black Spot in Vision of One Eye

7 min read

A black spot in the vision of one eye is probably a harmless floater, but there can be a more serious cause requiring treatment.
Heather Cottrell

Heather Cottrell

Logo_Corneacare_White

    • Shop
    • Wholesale
    • Education
    • Community
    • App
    • Eye Glossary
    Menu
    • Shop
    • Wholesale
    • Education
    • Community
    • App
    • Eye Glossary
    • Contact
    • Terms of service
    • Privacy policy
    • Shipping & Returns
    • Contact
    • Terms of service
    • Privacy policy
    • Shipping & Returns
    • Education
    • Shop
    • Wholesale
    • Contact
    • Terms of service
    • Privacy policy
    • Shipping & Returns
    • Education
    • Shop
    • Wholesale
    • Contact
    • Terms of service
    • Privacy policy
    • Shipping & Returns
    • Education
    • Shop
    • Wholesale
    • Contact
    • Terms of service
    • Privacy policy
    • Shipping & Returns
    • Education
    • Shop
    • Wholesale
    • Contact
    • Terms of service
    • Privacy policy
    • Shipping & Returns
    Instagram Facebook_Pink Youtube Twitter Tiktok
    Copyright – © 2023 CorneaCare, Inc. ⚡️ All rights reserved
    *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease

    Wholesale inquiry

    Please fill out the form below, and we will be in touch shortly.

    20% OFF personalized, convenient and effective eyecare
    20% OFF personalized eyecare
    Take the quiz
    Take the quiz