title: Retrobulbar hemorrhage during or after endonasal or periorbital surgery: what to do, when and how to do it.
abstract: Retrobulbar hemorrhage (RBH) is an uncommon complication of endoscopic sinus surgery or periorbital surgery consisting in an accumulation of blood within the orbit posteriorly to the eyeball. It must be treated within 90-100 minutes to avoid irreversible visual loss. The present paper tries to pinpoint the key steps in diagnosis and treatment of RBM.On the wake of a new case, the authors review and update their clinical experience and propose a step-by-step protocol to diagnose and to treat RBH developing under different circumstances: during endoscopic sinus surgery, during periorbital surgery, immediately after the surgery, in the awakening room, or postoperatively in the ward.A therapeutic ladder is proposed that starts with lateral canthotomy and inferior cantholysis and progresses to a lower lid transconjunctival incision with retrocaruncular extension.Based on our experience, the proposed guidelines are effective in diagnosing and treating RBH. They allow to preserve vision and minimize reliquates of this rare and dangerous surgical emergency.
authors.affiliation: *Department of Head and Neck Surgery, Section of Maxillo Facial Surgery, San Paolo Hospital, University of Milan, Milan †G.B. Bietti Foundation for Study and Research in Ophthalmology-IRCCS, Rome ‡Department of Head and Neck Surgery, Section of Otolaryngology, San Paolo Hospital, University of Milan, Milan §Department of Head and Neck Surgery, Section of Ophthalmology, San Paolo Hospital, University of Milan, Milan ||Department of Health Sciences, Division of Oral Surgery, San Paolo Hospital, University of Milan, Milan, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Colletti
authors.forename: Paolo
authors.initials: P
authors.lastname: Fogagnolo
authors.forename: Fabiana
authors.initials: F
authors.lastname: Allevi
authors.forename: Dimitri
authors.initials: D
authors.lastname: Rabbiosi
authors.forename: Valentina
authors.initials: V
authors.lastname: Bebi
authors.forename: Luca
authors.initials: L
authors.lastname: Rossetti
authors.forename: Matteo
authors.initials: M
authors.lastname: Chiapasco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Felisati
mesh_terms: D016063:Blood Loss, Surgical; D004630:Emergencies; D004724:Endoscopy / Q000009:adverse effects*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D009915:Orbit / Q000601:surgery*; D009916:Orbital Diseases / Q000601:surgery*; D019315:Retrobulbar Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery