Bleeding behind the eye, medically termed retrobulbar hemorrhage, is a serious condition that demands immediate medical attention. This occurrence carries a significant potential for vision loss and other serious complications if not addressed promptly.
What is Bleeding Behind the Eye
Retrobulbar hemorrhage involves bleeding within the orbit, the bony cavity that encases and protects the eyeball. This space, which also contains muscles, nerves, and fatty tissue, is confined. When blood accumulates in this limited area behind the eye, it causes a rapid increase in pressure. This elevated pressure can compress the optic nerve and compromise the blood supply to the eye, jeopardizing its function. Such pressure can lead to orbital compartment syndrome, a condition where increased pressure blocks ocular perfusion, damaging the optic nerve and potentially leading to permanent vision loss.
Common Causes
Trauma is a frequent cause of retrobulbar hemorrhage, resulting from blunt force injuries to the eye or head. Activities like sports, falls, or car accidents can cause blood vessels within the orbit to rupture. This type of injury can sometimes coincide with orbital fractures, contributing to the bleeding.
Certain medical conditions also increase the risk of bleeding behind the eye. Uncontrolled high blood pressure, or hypertension, can weaken blood vessels, making them susceptible to rupture. Blood clotting disorders, such as hemophilia, or the use of anticoagulant medications (blood thinners) can impair the body’s natural ability to stop bleeding. Vascular malformations can also predispose individuals to orbital bleeding.
Bleeding behind the eye can also occur as a complication of surgical procedures involving the eye or orbit, such as eyelid or other facial surgeries. Other factors such as tumors or inflammatory conditions within the orbit can lead to vessel fragility and bleeding. Activities that cause a sudden increase in pressure, like a strong sneeze, can cause retrobulbar hemorrhage, particularly in individuals on blood thinners.
Recognizing the Signs
A noticeable symptom is proptosis, the bulging of the affected eye. Bruising around the eye, known as periorbital ecchymosis, along with swelling of the eyelids, is common.
Vision changes are a key indicator, including blurry vision, double vision, or a partial to complete loss of sight. Patients report severe pain behind or around the eye, which can be intense. Difficulty or inability to move the eye in certain directions is another concerning sign. Additional symptoms include redness of the eye, a sensation of pressure within the orbit, and nausea and vomiting due to increased intraocular pressure. These symptoms, particularly if they appear suddenly or after a traumatic event, require immediate medical evaluation.
Diagnosis and Treatment Approaches
Seeking emergency medical care as soon as retrobulbar hemorrhage is suspected is critical. Delaying treatment can lead to permanent vision loss due to continuous pressure on the optic nerve. Intervention within 90 to 120 minutes of symptom onset is crucial to prevent permanent damage.
Doctors confirm the diagnosis through an eye examination, assessing vision, pupillary response, and eye movement. Imaging studies, such as computed tomography (CT) scans or magnetic resonance imaging (MRI) of the orbit, are used to visualize the bleeding, determine its extent and impact on the optic nerve and other orbital structures. While CT scans are preferred for their speed and ability to show bony anatomy, treatment should not be delayed by waiting for imaging if signs of vision compromise are clear.
Treatment strategies vary based on the severity and cause of the hemorrhage. For mild cases without immediate vision compromise, conservative management involving close observation and pain management is sufficient. Medical management includes medications to reduce orbital pressure, such as corticosteroids and osmotic agents like mannitol or acetazolamide. Addressing underlying causes, such as controlling high blood pressure or reversing the effects of anticoagulant medications, is important.
Surgical intervention becomes necessary in cases of rapidly worsening vision or severe pressure. Lateral canthotomy is a procedure performed to quickly relieve orbital pressure by making an incision at the outer corner of the eye. This allows the eye to decompress and reduces pressure on the optic nerve. If this initial procedure is insufficient, more invasive orbital surgery can be performed to drain the hematoma and further decompress the orbit.