retrobulbar hemorrhage after blowout fracture reconstruction: a case report

purpose : to report a case of total blindness a few hours after orbital blowout fracture repair the visual acuity (va) returned to normal after immediate reoperation. case report : a 21-year-old man with obvious enophthalmos in the left side, 2 weeks after car accident, was candidate for orbital floor reconstruction surgery. anterior orbitotomy from subcilliary incision was done and at the end of the surgery, titanium medpore inserted in orbital floor. three hours after surgery patient complained of severe pain and a significant proptosis was noticed. va was no light perception (nlp) and relative afferent pupillary defect (rapd) was positive. the patient reoperated and medpore plate was removed. there was significant blood in orbital cavity that was totally removed. three hours after reoperation proptosis disappeared and va improved to 3m count finger. one week after the surgery the va was raised to 20/20. conclusion : acute severe pain in the early postoperative period, may be a sign of the orbital hemorrhage. awareness of the potential severity of this complication and execution of appropriate treatment with minimal delay, may result in rapid and complete visual recovery.    iranian journal of ophthalmology 201123(2):69-71 © 2011 by the iranian society of ophthalmology