Retrobulbar Hemorrhage During or After Endonasal or Periorbital Surgery

To describe demographic and clinical features of emergency department patients presenting with fractureassociated (FA) or fracture-independent retrobulbar hemorrhage (RBH).Methods: The Nationwide Emergency Department Sample database 2018 and 2019 was used to compare demographic and clinical features of patients with fracture-independent RBH and FA RBH.Results: A total of 444 fracture-independent and 359 FA RBH patients were identified. Demographics such as age distribution, gender, and payer type differed significantly, with young (21-44 years), privately insured males more likely to develop FA RBH and the elderly (65+ years) more likely to develop fracture-independent RBH. Prevalence of hypertension and anticoagulation did not differ, but substance use and ocularrelated injuries were more prevalent in the FA RBH.Conclusion: Presentations of RBH differ in demographic and clinical features. Further research is needed to explore trends and guide decision-making in the emergency department.

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“…Previous investigations underscore the need to evacuate the hemorrhage, control bleeding, and decompress the orbit. 20,21…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Retrobulbar Hemorrhage Presentation in the Emergency Department

Tram

Pauze

Wladis

2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…Even more so, the anterior skull base is separated from the orbit by thin bony sheaths only. Thus improper approaches to fractures of the medial wall are far more hazardous and may potentially lead to severe or disastrous complications (Colletti et al, 2012(Colletti et al, , 2015. This may be the real reason why treatment of fractures of the medial wall of the orbit have long been left untreated, with obvious consequences.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal repair with polyethylene implants in medial orbital wall fractures: A prospective study on 25 cases

Colletti

Saibene

Giannini

et al. 2018

Journal of Cranio-Maxillofacial Surgery

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The aim of the study was to assess the mid-term effectiveness and safety of an original technique consisting of reconstructing fractures of the medial wall of the orbit with porous polyethylene implants with an exclusive transnasal approach. Twenty-five patients were treated. Each patient underwent a pre-operative ophthalmologic evaluation and a CT scan. The surgery started with an anteroposterior ethmoidectomy of the fractured side; all the fractured bone fragments were removed and all usual landmarks of healthy bony margins were identified. A Medpor sheet was placed endoscopically to reconstruct the fractured wall. Each patient received an immediate postoperative CT scan, and was evaluated at day 1, 7, 30 and 6 months after surgery clinically and with an endoscopic examination. In all patients, preoperative enophthalmos and/or diplopia were corrected. The CT scans showed excellent reconstruction of the fractured bony walls. The immediate postoperative period was characterized by a very high degree of subjective comfort. No perioperative complications were detected. At the 6 months follow up, all meshes appeared covered by epithelialized mucosa at the endoscopic inspection, and clinical results were stable. Scars or lid complications are always prevented. The technique described has become the standard to treat medial wall fractures in our department.

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“…Da in der Literatur ein kritisches Zeitfenster von 90 – 120 min. nach Symptombeginn angegeben wird 3 und nach Ablauf dieser Zeit die Wahrscheinlichkeit eines dauerhaften Visusverlusts erhöht ist, sollte die laterale Kanthotomie/-lyse als allererster Schritt vor der weitergehenden Diagnostik durchgeführt werden. Meist ist ein erneuter operativer Eingriff im Bereich des lateralen Lidwinkels zur kosmetischen Lidkorrektur nicht erforderlich.…”

Section: Schritt 1 Indikationsstellungunclassified