Efficacy of Transcutaneous Transseptal Orbital Decompression in Treating Acute Retrobulbar Hemorrhage and a Literature Review

Abstract

EtiologyRetrobulbar hemorrhage (RBH) is an uncommon but potentially blinding orbital emergency in which immediate diagnosis and treatment are necessary to maintain or reconstitute visual acuity. The literature indicates that two main causes of RBH can be distinguished as: traumatic and nontraumatic. Traumatic causes of RBH can be further classified into nonpenetrating and penetrating trauma. Penetrating orbital trauma is essentially iatrogenic. The most common causes AbstractDecreasing visual acuity secondary to orbital trauma may be caused by sudden spaceoccupying or expanding intraorbital lesions, including retrobulbar hemorrhage (RBH), herniation, or swelling. RBH must be diagnosed and treated immediately. This article addresses the efficacy of transcutaneous transseptal orbital decompression in a combination with a systematic review of the literature for a comparison of this method with existing treatment options. For this study the department's database was retrospectively screened for patients with acute RBH who were treated between 2009 and 2011 using the authors' approach. Patients presenting with RBH were classified into RBH classes I to III according to three different clinical and radiological manifestations of acute RBH. The efficacy of transcutaneous transseptal orbital decompression was assessed by postoperative visual acuities. The literature review was performed by using the MEDLINE database. The time period for the study was between 2009 and 2011 during which 10 patients were diagnosed with suspected RBH and 9 were treated with the authors' technique. Visual acuities were reconstituted or maintained in almost 86% of patients who were diagnosed and treated according to the authors approach and who survived initial trauma. It was concluded that transcutaneous transseptal orbital decompression provides an efficient and rapid approach for treating patients with acute RBH. By distinguishing three different manifestations of acute RBH, the authors present a diagnostic tool that may facilitate classification of RBH and determination of treatment options.

Association of Midfacial Fractures with Ophthalmic Injury

“…Another procedure used to decompress the orbit is called transcutaneous, transseptal orbital decompression. 12 It decreases pressure in the orbit rapidly and with this procedure it is possible to evacuate blood that might otherwise stay trapped when performing a lateral canthotomy. It is a more extensive approach.…”

“…Acute RBH can be classified into three categories according to Zimmer et al 12 RBH Class I is defined as a patient presenting with orbital injury without specific clinical or radiological signs, Class II is defined as a patient presenting with orbital injury with either clinical or radiological signs, and Class III is defined as a patient presenting with orbital injury and clear clinical and radiological signs. In our study, one patient presented with RBH Class III.…”

Diagnosis and Treatment of Optic Nerve Trauma

“…Three different clinical and radiological manifestations of acute RBH can be distinguished and used for the classification of RBH into classes I to III. 47 The most significant clinical and radiological findings can be divided into specific and nonspecific clinical signs and symptoms and radiological findings, respectively. According to this classification, treatment strategies can be determined.…”

“…1C) has evolved from the basic treatment requirements of acute RBH, namely, rapid pressure release and drainage of hemorrhage. 47 Drainage of hematoma from the orbital compartment without osteotomy of orbital walls can only be performed through the orbital septum. Pulsating exophthalmos, which may be a sign of carotid-cavernous sinus fistula, is the only contraindication for surgical treatment.…”

“…74 Multislice spiral CT (slice thickness, 1 mm; table advance, 2 mm; increment, 1 mm) is currently the method of choice for assessing radiologic signs of traumatic optic nerve damage. 47,75 Occasionally, only cases of direct constriction of the optic canal are classified as surgical emergencies, but subsequently, this condition can result in transethmoidal decompression of the optic nerve. 76 However, the pathomechanism of optic nerve compression in the optic canal does not require a clearly identifiable fracture.…”