Retrobulbar hemorrhage and prasugrel

Abstract

Retrobulbar hemorrhage and prasugrelRetrobulbar hemorrhage (RBH) is the accumulation of blood in the orbit behind the globe. Although some hemorrhages are minor and do not result in significant mass effect, an RBH is an ophthalmologic emergency requiring immediate surgical intervention. An RBH manifests as acute ipsilateral orbital pain and proptosis and can be variably associated with loss of vision, ophthalmoplegia, subconjunctival hemorrhage, and increased intraocular and intraorbital pressure. 1 Most cases of RBH are traumatic or postsurgical, but some occur spontaneously in patients with bleeding diatheses. Another etiology for RBH is retrobulbar anesthesia injection. 1 The use of antiplatelet therapy has not been considered to be a significant risk factor for RBH 1,2 ; yet newer, more potent antiplatelet agents may carry significantly more risk for RBH. We report a case of RBH causing blindness in a patient taking aspirin and prasugrel. To our knowledge, this is the first such case reported in the English-language ophthalmic literature. DISCUSSIONRBH is a potentially visually devastating complication of retrobulbar anesthesia. Although older literature

Spontaneous retrobulbar haemorrhage associated with anticoagulants

“…Los principales signos clínicos de esta patología son proptosis, dolor ocular, disminución de agudeza visual, oftalmoplejia, resistencia a la retropulsión ocular, quemosis conjuntival, edema de papila, congestión venosa e isquemia retiniana 1 , 4 . La sospecha rápida inicial es fundamental, puesto que el diagnóstico es clínico.…”

“…La hemorragia retrobulbar consiste en el sangrado en la región intraorbitaria retroseptal. Al encontrarse entre los huesos orbitarios y el propio septo orbitario, es una región poco distensible; por ello se genera un síndrome compartimental en el que, sin una resolución quirúrgica urgente, la isquemia mantenida de los tejidos intraorbitarios más nobles provocará una pérdida visual irreversible 1 .…”

Delayed-type retrobulbar hematoma caused by low temperature after reconstruction of inferior blow-out fracture

“…Son et al reported that anticoagulants, though not acetylsalicylic acid, significantly increase the risk of retrobulbar hemorrhage [ 11 , 12 ]. Contrarily, Matharu et al [ 13 ] reported a case of retrobulbar hemorrhage in a patient on dualantiplatelet therapy (acetylsalicylic acid and prasugrel). The authors emphasized the importance of investigating the medical history for antithrombotic agent usage in patients with orbital fractures or retrobulbar injections [ 11 , 13 ].…”

“…Contrarily, Matharu et al [ 13 ] reported a case of retrobulbar hemorrhage in a patient on dualantiplatelet therapy (acetylsalicylic acid and prasugrel). The authors emphasized the importance of investigating the medical history for antithrombotic agent usage in patients with orbital fractures or retrobulbar injections [ 11 , 13 ]. However, our patient did not have such a medical history.…”

Ambulatory Eye Surgery and Antithrombotic Therapy – New Approaches

“…She presented for panretinal photocoagulation under retrobulbar block but she developed retrobulbar hemorrhage. Newer, more potent Aptl drugs might carry higher risks of severe bleeding complications in susceptible patients ( 18 ). Anesthesiologists and ophthalmologists should consider delay of the surgery until dual Aptl therapy is no longer needed, to hold prasugrel or avoid retrobulbar blocks and choose different regional ophthalmic blocks such as peribulbar block with the use of ultrasound.…”