Abstract: We experienced and report on a case of retrobulbar hematoma caused by bleeding from the orbital branch of the infraorbital artery after a medial orbital wall reconstruction.
A healthy 28-year-old man struck his left eye while playing baseball before admission. A computed tomographic scan revealed an approximately 13 × 12-mm–sized fracture of the left orbit medial wall. The medial orbit wall was reconstructed through a subciliary approach on the 18th day after the injury. Approximately 15 hours after the orbit wall reconstruction, the patient complained of pain in the left orbital area, headache, and vomiting. Upon an examination, swelling and ecchymosis were observed on the left eye. His visual acuity was 0.8 (oculus dexter [OD])/0.4 (oculus sinister [OS]) and the intraocular pressure was 18 (OD)/24 (OS) mm Hg by a Goldmann applanation tonometry. A computed tomographic scan showed an intraorbital hematoma and proptosis on the left side. In an emergency operation, a hematoma with a volume of approximately 2 to 3 mL was evacuated and an active bleeding point was noted on the orbital floor, which was thought to be the orbital branch of the infraorbital nerve. The bleeding point was cauterized. After the operation, his visual acuity was 1.0 (OD)/0.8 (OS) and the ocular pressure normalized to 16 (OD)/16 (OS) mm Hg by a Goldmann applanation tonometry.
Close observation and meticulous hemostasis along the infraorbital groove may be needed in an orbital floor exploration to prevent postoperative orbital hematoma.