RETROBULBAR HEMORRHAGE: CURRENT CONCEPTS IN PATHOPHYSIOLOGY, EARLY RECOGNITION, AND EMERGENCY MANAGEMENT

Background: Retrobulbar hemorrhage (RBH) is an uncommon yet potentially vision-threatening orbital emergency characterised by bleeding within the retrobulbar space, resulting in a rapid rise in intraorbital pressure and risk of optic nerve ischemia. Objective:This review aims to summarise the current evidence regarding the aetiology, clinical presentation, diagnosis and management strategies of RBH, with a focus on timely intervention and improved outcomes. Methods: A narrative review of the literature was conducted, focusing on the aetiology, pathophysiology, clinical features, and therapeutic approaches associated with RBH in trauma, surgical, and non-traumatic settings. Results: Retrobulbar hemorrhage (RBH) most commonly follows facial trauma, orbital or maxillofacial surgery, and local anaesthetic injections, although vascular abnormalities and coagulopathies may also contribute. Clinically, it presents with proptosis, severe orbital pain, reduced visual acuity, ophthalmoplegia, and relative afferent pupillary defect. Prompt recognition is essential to prevent irreversible vision loss. Management includes medical reduction of intraocular and intraorbital pressure; however, emergency lateral canthotomy and cantholysis remain the definitive vision-saving interventions when optic nerve perfusion is compromised. Conclusion: RBH requires immediate diagnosis and management to prevent permanent vision loss. Increased awareness, perioperative vigilance, and standardised emergency protocols are essential for enhancing clinical outcomes and minimising associated morbidity.