Synopsis
Identify pressure-threatening orbital haemorrhage clinically, distinguish it from other traumatic visual problems, and initiate immediate decompression pathways without avoidable imaging or transfer delay.
- Retrobulbar haemorrhage describes blood behind the eye; orbital compartment syndrome describes the dangerous pressure and perfusion effect, so the terms are not interchangeable.
- Assess vision, pupils, colour perception when feasible, proptosis, lid tension and eye movements immediately after a concerning injury or procedure.
- The diagnosis of a threatened orbital compartment is clinical; CT is useful after initial treatment or when uncertainty can be resolved without delaying necessary care.
Key red flags
Rapid visual decline with tense proptosis, restricted movements and an afferent pupillary defect after trauma or an orbital procedure demands immediate assessment for orbital compartment syndrome and urgent decompression.
Investigation priorities
Identify evolving afferent dysfunction during the first clinical assessment.
Management branches
Rapid visual compromise occurs with a tense protruding eye after trauma or an orbital procedure.
- Call senior emergency, ophthalmic and surgical support, documenting the onset and essential acuity and pupillary findings while preparing immediate treatment.
- Have a clinician capable of the procedure perform urgent lateral canthotomy and appropriate cantholysis when clinically indicated, without waiting for CT or transport.