Early Detection of Traumatic Retrobulbar Hemorrhage Using Bedside Ocular Ultrasound.

A 35-year-old man with no prior medical history presented to the Emergency Department (ED) with left eye pain and blurry vision 1 h after blunt traumatic injury from a direct punch. On examination, he was afebrile with a blood pressure of 119/73 mm Hg, a regular heart rate of 52 beats/min, and a Glasgow Coma Scale score of 15. Physical examination revealed proptosis and significant periorbital edema. Complicated lacerations of the upper and lower eyelids were present medial to the lacrimal punctum, with obvious involvement of the canalicular system. Elevation of the eye was absent and painful. Visual acuity was 20/25 on the right and 20/30 on the left. No pupillary abnormality or resistance to retropulsion of the globe was present. Bedside ocular ultrasonography of the left orbit was performed and demonstrated a thin anechoic stripe posterior to the globe, suggesting an early retrobulbar hemorrhage (RBH) (Figure 1). Further imaging identified hypoechoic fluid collections posterior to this stripe, indicating RBH (Figure 2). Ophthalmology was consulted and within 30 min of the ultrasound, a maxillofacial computed tomography (CT) scan confirmed retrobulbar stranding consistent with RBH causing proptosis of the left globe (Figure 3). There were also multiple orbital floor fractures, lamina papyracea fractures, and hemosi-