Lateral Canthotomy and Cantholysis for Spontaneous Retrobulbar Hemorrhage With Normal Intraocular Pressures: Case Report and Review of the Literature

Abstract

Spontaneous retrobulbar hemorrhage (RBH) is uncommon and typically occurs secondary to vascular malformations, coagulopathies, hypertension, or strenuous activities in the setting of elevated intraocular pressure (IOP). RBH can cause orbital compartment syndrome (OCS) with resultant permanent vision loss. We present a case of spontaneous RBH in an 18-year-old male with a history of acute lymphoblastic leukemia (ALL) and sepsis. While IOPs were normal, the patient exhibited symptoms of OCS in which a lateral canthotomy and cantholysis were performed. This case highlights the importance of the clinical exam when treating a patient with suspected OCS and demonstrates that intraocular pressures need not be elevated for both diagnosis and intervention.