TRAUMATIC RETROBULBAR HEMORRHAGE:
Symptoms:
Pain, decreased vision, recent history of trauma or surgery to the eye or orbit.
Critical Signs:
Proptosis with resistance to retropulsion, diffuse subconjunctival hemorrhage extending posteriorly.
Other Signs:
Eyelid ecchymosis, chemosis, congested conjunctival vessels, increased intraocular pressure (IOP); sometimes, limited extraocular motility in any or all fields of gaze.
Differential Diagnosis:
Orbital cellulitis (Fever, proptosis, chemosis, limitation of eye movements with pain on motion; also may follow trauma, but generally not so acute. See Orbital Cellulitis, Section 7.4).
Orbital fracture (blow-out, medial wall, or tripod fracture). (Limited extraocular motility, infraorbital hypesthesia, and crepitus. Enophthalmos, not proptosis, may be present. See Section 3.10).
Ruptured globe (Subconjunctival edema and hemorrhage may mask a ruptured globe. A shallow or deep anterior chamber (as compared to the other eye), hyphema, and limitation of ocular motility are often present. Intraocular pressure (IOP) is commonly low, and there is usually no proptosis. See Ruptured Globe and Penetrating Ocular Injury, Section 3.14).
Carotid–cavernous fistula (May follow trauma; pulsating exophthalmos, ocular bruit, corkscrew-arterialized conjunctival vessels, chemosis. IOP may be increased. Often bilateral involvement because of venous communications. See Cavernous Sinus/Superior Orbital Fissure Syndrome, Section 11.9).
Varix (Increased proptosis with Valsalva maneuver. Is not usually seen acutely, and there is usually no history of trauma or surgery).
Symptoms:
Pain, decreased vision, recent history of trauma or surgery to the eye or orbit.
Critical Signs:
Proptosis with resistance to retropulsion, diffuse subconjunctival hemorrhage extending posteriorly.
Other Signs:
Eyelid ecchymosis, chemosis, congested conjunctival vessels, increased intraocular pressure (IOP); sometimes, limited extraocular motility in any or all fields of gaze.
Differential Diagnosis:
Orbital cellulitis (Fever, proptosis, chemosis, limitation of eye movements with pain on motion; also may follow trauma, but generally not so acute. See Orbital Cellulitis, Section 7.4).
Orbital fracture (blow-out, medial wall, or tripod fracture). (Limited extraocular motility, infraorbital hypesthesia, and crepitus. Enophthalmos, not proptosis, may be present. See Section 3.10).
Ruptured globe (Subconjunctival edema and hemorrhage may mask a ruptured globe. A shallow or deep anterior chamber (as compared to the other eye), hyphema, and limitation of ocular motility are often present. Intraocular pressure (IOP) is commonly low, and there is usually no proptosis. See Ruptured Globe and Penetrating Ocular Injury, Section 3.14).
Carotid–cavernous fistula (May follow trauma; pulsating exophthalmos, ocular bruit, corkscrew-arterialized conjunctival vessels, chemosis. IOP may be increased. Often bilateral involvement because of venous communications. See Cavernous Sinus/Superior Orbital Fissure Syndrome, Section 11.9).
Varix (Increased proptosis with Valsalva maneuver. Is not usually seen acutely, and there is usually no history of trauma or surgery).