Post-op eye observations
Retrobulbar haemorrhage is a very rare condition that can result in loss of vision.
Where bleeding into the orbital space can result in compression of the optic nerve, leading to ischaemia and eventually blindness.
It can follow both trauma and surgery to the orbital region
Trauma
Infra-orbital
Zygomatic
Le Fort
Post-op
Blepheroplasty
Zygomatic reduction
Le Fort reduction
It is essential that eye observations are carried out, post-operatively
Every ¼ hr for 2 hours
Every ½ hr for 2 hours
1 hourly for 4 hours
4 hourly for 24 hours
It is characterised by five signs/symptoms:
- PAIN (Sharp, within the globe of the eye itself)
- PROPTOSIS (‘bulging eye’)
- PUPIL REACTION to light is lost
- PARALYSIS (movement of the eye is restricted)
- VISUAL ACUITY (is reduced like a curtain falling)
‘HOT ANGRY EYE’
Treatment
Immediate action
Inform 2nd on call
Remove any sutures in the area, for pressure relief
Medication
1. Mannitol 1g/Kg as 20% infusion
Osmotic diuretic
Contra-indicated in congestive heart failure and pulmonary oedema
2. Acetazolamide 500mg IV
Monitor FBC/U+E
Reduces aqueous pressure by inhibition of carbonic anhydrase (used in glaucoma)
Dexamethasone - 8mg po
Papaverine - 40mg smooth muscle relaxant
Dextran 40 - 500mls IV improves perfusion