A case report of a patient with spontaneous retrobulbar hemorrhage

Abstract

Introduction: Retrobulbar hemorrhage (RBH) is a potentially blinding consequence of orbital trauma that can lead to orbital compartment syndrome (OCS). Although RBH commonly follows trauma, spontaneous cases have been reported, often associated with coagulopathies, thrombolytic therapy, lymphangiomas, or Valsalva maneuvers. In some cases, however, no risk factors are identified. OCS should be suspected in the presence of declining visual acuity, proptosis, raised intraocular pressure, a tight orbit, relative afferent pupillary defect, intraocular vascular changes, or restricted eye movements. Timely recognition of RBH is essential to prevent ischemic blindness.

Case report: We report a 17-year-old healthy female who presented with sudden right eye proptosis, reduced ocular motility, and visual decline. She denied trauma or medication use. Initially treated for orbital cellulitis with intravenous antibiotics for a week without improvement, she was referred to our facility. Examination suggested OCS, prompting emergency canthotomy and cantholysis, followed by orbitotomy, which evacuated about 10 mL of blood. Postoperatively, proptosis resolved, but vision remained no perception of light. This case highlights the rarity of spontaneous RBH and the importance of maintaining a high index of suspicion in acute proptosis. It also underscores the role of prompt imaging and intervention in preserving vision.

Conclusion: RBH with OCS is an ophthalmic emergency requiring urgent diagnosis and management to prevent irreversible vision loss.