[Blindness caused by retrobulbar hemorrhage (orbital compartment syndrome)].
In the author's department, 5 patients developed retrobulbar hemorrhage from the 199 patients with midface fractures, between August 2007 and March 2010 (2.5%). 4 of these patients became irreversibly blind on the affected eye. With timely treatment, one patient avoided blindness. The author presents a retrospective analysis of the patients from different departments with midface/orbital fractures and blindness. Bleeding and oedema behind the eyeball due to midface/orbital fractures in the relatively non-expandable orbit results a quick elevation of orbital pressure and consequently diminished circulation, ischemia, and later necrosis of the optic nerve (orbital compartment syndrome) with irreversible blindness. Immediate medical (high dose of intravenous steroids, mannitol, acetazolamide) and surgical intervention (lateral canthotomy, cantholysis, orbitotomy) on noticing the signs (proptosis, ecchymosis, ophthalmoplegia, mydriasis) and symptoms (pain, diplopia, decreased visual acuity, blindness), of a retrobulbar hemorrhage could theoretically give a chance to save the affected eye. Treatment started beyond 20 minutes of onset of blindness, might not revert the vision. Unfortunately, the description and treatment of the retrobulbar hemorrhage and the orbital compartment syndrome is not within the curriculum of the medical university, thus young colleagues could have vague idea about the diagnosis, the urgency and the treatment - as shown in these cases. With the introduction of these cases the author would like to highlight the signs, symptoms and necessary treatment. Knowledge of the disease could also increase the detected number of retrobulbar hemorrhages, which might be less rare than we think. Including the disease into the medical curriculum and postgraduate trainings could help to reduce the number of sad cases in the future.
Klenk
Gusztáv
G
Fovárosi Onkormányzat Szent János Kórháza és Eszak-budai Egyesített Kórházai, Fül-, Orr-, Gége- és Szájsebészeti Osztály Budapest. gusztavklenk@yahoo.co.uk
D000058:Accidental Falls; D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D001766:Blindness / Q000209:etiology*; D003161:Compartment Syndromes / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008446:Maxillofacial Injuries / Q000150:complications* / Q000209:etiology*; D008875:Middle Aged; D009917:Orbital Fractures / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D019315:Retrobulbar Hemorrhage / Q000150:complications* / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014754:Violence