Orbital Hematoma
Hemorrhage in the orbit usually caused by blunt or lacerating trauma, rarely by coagulopathy or vascular malformation
May produce “compartment syndrome” with increased intraocular pressure that threatens vision
May be accompanied by ocular, ocular adnexal, optic nerve, or orbital wall damage
Periocular pain
Proptosis
Swollen, often ecchymotic, lids
Reduced ocular motility
Hyperemic or hemorrhagic conjunctiva
Elevated intraocular pressure
Relative afferent pupillary defect
Signs of ocular trauma: lacerated or opaque cornea, hyphema, inflamed aqueous humor, displaced iris, vitreous hemorrhage, retinal contusion
Signs of ocular adnexal trauma: lacerated lids or lacrimal drainage system
Severe conjunctivitis
Endophthalmitis
Lid or orbital infection (“cellulitis”) or noninfectious inflammation
Carotid-cavernous fistula
Cavernous sinus thrombosis
Assess visual acuity and confrontation visual fields
Examine lids and lacrimal apparatus for lacerations
Assess eye movements
Perform slit lamp examination to assess cornea and anterior chamber
Attempt ophthalmoscopy to assess clarity of ocular media
Measure intraocular pressure; if above 30mmHg, perform emergent lateral canthotomy and cantholysis
Canthotomy: make a 1-2 cm full-thickness horizontal incision under local anesthesia at angle of lateral canthus
Cantholysis: retract lower lid downward, dissect, and cut lateral canthal tendon
Refer patient for orbital non-contrast CT scan after performing canthotomy/cantholysis
Canthotomy and cantholysis usually lower intraocular pressure to safe levels (below 30mmHg); if intraocular pressure remains high, refer promptly to an ophthalmologist
Orbit CT scan will reveal fresh orbital hemorrhage and orbital wall fractures, and rule out co-existing trauma to the facial and skull bones and cranial cavity
Isolated orbital hemorrhage without damage to the eye or its adnexal tissue will usually be absorbed without permanent damage
