Unilateral blindness due to retrobulbar hematoma after lower blepharoplasty

Blepharoplasty is one of the most popular cosmetic surgical procedures for people who are concerned with minimizing the effects of aging and maintaining an aesthetically attractive appearance. If periorbital surgery is not performed by an expert, the risk of complications increases. In particular, retrobulbar hematoma, which is the most serious complication after blepharoplasty, can lead to permanent blindness. We report a rare case of unilateral permanent blindness due to careless and unprofessional treatment following a retrobulbar hematoma after lower blepharoplasty. In conclusion, it is necessary to check for symptoms and signs including pain, proptosis, visual acuity, and light reflex after the operation. Careful instructions should then be given to patients and their caregivers to avoid actions that may cause postoperative bleeding. We emphasize that if a patient complains of symptoms, painkillers should not be used and computed tomography should be performed for an accurate and rapid diagnosis. Appropriate procedures must then be taken to prevent permanent vision loss.

Retrobulbar Hematoma in Blow-Out Fracture after Open Reduction

Retrobulbar hemorrhage, especially when associated with visual loss, is a rare but significant complication after facial bone reconstruction. In this article, two cases of retrobulbar hematoma after surgical repair of blow-out fracture are reported. In one patient, permanent loss of vision was involved, but with the other patient, we were able to prevent this by performing immediate decompression after definite diagnosis. We present our clinical experience with regard to the treatment process and method for prevention of retrobulbar hematoma using a scalp vein set tube and a negative pressure drainage system.

A Case Report of Bilateral Retrobulbar Hemorrhage after Lower Blepharoplasty

Retrobulbar hemorrhage is a rare but serious complication after blepharoplasty, mid-face injury, and treatment of facial bone fractures. The incidence of postoperative retrobulbar hemorrhage is 0.055% with an incidence of associated permanent blindness of 0.005%. A 69-year-old male came to the emergency room with pain on both orbital areas and uncontrolled bleeding after cosmetic lower blepharoplasty performed at a private clinic. He had not been evaluated preoperatively by the private clinic, but we found that he had undergone percutaneous transluminal coronary angioplasty and taken anticoagulants for 10 years. We performed an emergency operation to evacuate the hematoma. However, after surgery, he persistently complained of orbital pain, pressure and diminished visual acuity. Intraocular pressure was increased, and computed tomography demonstrated a retrobulbar hemorrhage with globe displacement. Emergent lateral canthotomy and cantholysis were performed. Intraocular pressure was decreased to 48/30 mm Hg immediately after the operation, falling within the normal range the next day. We recommend three points to minimize loss of vision by retrobulbar hematoma. Firstly, careful preoperative evaluation must be conducted including current medications, underlying diseases and previous history of surgeries. Secondly, cautious postoperative observation is important for the early diagnosis of retrobulbar hematoma. Lastly, immediate treatment is crucial to prevent permanent blindness.

Bilateral Retrobulbar Hemorrhage and Visual Loss Following Traumatic Asphyxia

Retrobulbar hemorrhage and permanent visual loss are rare presentations following traumatic asphyxia. In this case, bilateral permanent visual disturbance developed in a woman after chest-crushing trauma without direct trauma to the orbits. A computed tomography scan confirmed bilateral retrobulbar hemorrhages. An ophthalmologic exam revealed bilateral subconjunctival hemorrhages and severe lid edema. Despite high-dose steroid therapy, visual recovery was limited, and optic nerve atrophy developed. Ischemia of the optic nerve associated with retrobulbar hemorrhage may be postulated as one of the causes of permanent visual impairment following traumatic asphyxia.

Delayed Retrobulbar Hemorrhage after Orbital Floor Reconstruction

PURPOSE: Retrobulbar hemorrhage is a rare complication followed by blepharoplasty, trauma, orbital reconstruction, and so on. Most of the cases occur within 24 hours, half of them in the first 6 hours. Some authors have reported delayed retrobulbar hemorrhage after blepharoplasty and trauma within 1 day to 9 days. However, there have been few reports of delayed retrobulbar hemorrhage resulting from the complication of orbital reconstruction. METHODS: A 22-year-old male underwent orbital floor reconstruction due to the orbital floor fracture. In 84 hours after the surgery, he complained sudden onset orbital pain and decreased visual acuity immediately after defecation. Intraocular pressure was unmeasurable due to the swelling at that time. Emergency computed tomography was performed. RESULTS: Computed tomography revealed subperiosteal hematoma on inferior orbital wall extended to the apex. Emergency decompressive surgery was performed within 1 hour. After evacuation of hematoma, orbital symptom was improved and visual acuity was restored. CONCLUSION: Delayed retrobulbar hemorrhage is rare but vision-threatening.Therefore early diagnosis and treatment of delayed retrobulbar hemorrhage is thought to be crucial. The cause of delayed hemorrhage was not clear, however, valsalva maneuver might be the cause of hemorrhage.

A Case of Retrobulbar Hemorrhage after Endoscopic Sinus Surgery with Microdebrider

Retrobulbar hemorrhage is one of the major complications following endoscopic sinus surgery (ESS) with a microdebrider. Symptoms and physical findings include temporary blindness, ophthalmoplegia, mydriasis, ptosis, proptosis and eyelid ecchymosis. Recently, we experienced a case of retrobulbar hemorrhage after an ESS with a microdebrider resulting from anterior ethmoid artery rupture. We hereby present this case with an emphasis on the importance of prevention, identification and management of retrobulbar hematoma.

A case of Retrobulbar Intramuscular Hematoma

PURPOSE: To report a case of retrobulbar hematoma within the lateral rectus muscle which resulted in sight-threatening complication. METHODS: A 40-year-old male presented with a chief complaint of painless mass and exophthalmos. Exicional biopsy via lateral orbitotomy and direct decompression of the muscle were performed to the diagnosis and treatment. RESULTS: After decompression, improvement of the exophthalmos was achieved. This case illustrated a potentially serious complication of retrobulbar hematoma following minor periorbital trauma. The successful outcome may be achieved by rapid diagnosis and intervention.

The Complications Developed after Repeated Botulinum Toxin Injection

PURPOSE: To investigate the incidence of complication associated with repeated botulinum toxin chemodenervation in extraocular muscle. METHODS: 47 patients who had taken botulinum toxin chemodenervation from 1996 to November 2001 were reviewed retrospectively. 10 patients had taken repeated injection. Saline diluted botulinum toxin was directly injected into the extraocular muscle through the Teflon coated needle. RESULTS: In 10 patients, 5 patients had complications which were 2 cases of hypertropia, 2 cases of ptosis and 1 case of retrobulbar hemorrhage who was 44 year old woman taken 5 times of botulinum toxin injection. She was successfully treated with lateral canthotomy and cantholysis. CONCLUSIONS: Rate of complication in repeated botulinum toxin chemodenervation was not different from that of single procedure. We experienced one case of retrobulbar hemorrhage in 10 patients with repeated botulinum injection.

Retrobulbar Hemorrhage during Cardiopulmonary Bypass Surgery

Retrobulbar hemorrhage is a rare complication following cardiopulmonary bypass surgery, which has never been reported in Korea. Our cardiac surgery tearn diagnosed a case of 30 year-old female patient as atrial septal defect and performed direct closure for it. Proptosis of the right eye was developed during surgery and she was consulted to Department of Ophthalmology, St. Mary's Hospital, Catholic University Medical College. We confirmed the evidence of the proptosis of the right eye with Hertel's exophthalmo meter and diagnosed this case as retrobulbar hemorrhage that orbital CT showed a large ovoid shaped non-enhancing hyperdense mass shadow at superior portion of the right orbit. So we report our case with a brief review of the literature related to retrobulbar hemorrhage during cardiopulmonary bypass surgery.

Right Retrobulbar Hemorrhage during Cardiopulmonary Bypass / 대한마취과학회지

We experienced a case of retrobular hemorrhage during cardiopulmonary bypass. Following factors are suspected as the cause retrobulbar hemorrhage in this patient; l ) Rupture of preexisting AV malformation or aneurysm. 2) Accidental high flow to innominate artery by Coanda effect or miscannulation, 3) Obstruction of right jugular venous drainage and therefore cerebrofacial flow is increased, 4) Increase bleeding tendency during cardiopulmonary bypass. Fortunetely, patient has no neurologic complication and well recovered from retrobulbar hemorrhage.