Blepharoplasty is one of the most popular cosmetic surgical procedures for people who are concerned with minimizing the effects of aging and maintaining an aesthetically attractive appearance. If periorbital surgery is not performed by an expert, the risk of complications increases. In particular, retrobulbar hematoma, which is the most serious complication after blepharoplasty, can lead to permanent blindness. We report a rare case of unilateral permanent blindness due to careless and unprofessional treatment following a retrobulbar hematoma after lower blepharoplasty. In conclusion, it is necessary to check for symptoms and signs including pain, proptosis, visual acuity, and light reflex after the operation. Careful instructions should then be given to patients and their caregivers to avoid actions that may cause postoperative bleeding. We emphasize that if a patient complains of symptoms, painkillers should not be used and computed tomography should be performed for an accurate and rapid diagnosis. Appropriate procedures must then be taken to prevent permanent vision loss.
Aging ; Blepharoplasty ; Blindness ; Caregivers ; Diagnosis ; Exophthalmos ; Hematoma ; Hemorrhage ; Humans ; Reflex ; Retrobulbar Hemorrhage ; Visual Acuity

PURPOSE: We report a case of superior orbital fissure syndrome induced by penetrating orbital injury caused by a steel wire and analyzed the clinical outcomes. CASE SUMMARY: A 49-year-old female visited our clinic after a penetrating orbital injury through the right inferolateral conjunctiva caused by a steel wire. The best corrected visual acuity of the right eye was 0.8 and a fixed dilated pupil was detected. Partial ptosis and ophthalmoplegia were observed in the right eye. The computed tomography image revealed no sign of orbital wall fracture, retrobulbar hemorrhage or foreign body. Slightly increased signal intensity was observed on the magnetic resonance image but other abnormal findings of the extraocular muscle and optic nerve were not detected. Under the impression of superior orbital fissure syndrome, systemic steroid was administered orally. After 1 month, ptosis and ophthalmoplegia were partially improved. After 3 months, the pupil size and response were normalized. CONCLUSIONS: The oral steroid treatment was given to reduce the edema without orbital wall fracture after the penetrating orbital injury, which caused the superior orbital fissure syndrome. The symptom was relieved 3 months after the injury.
Conjunctiva ; Edema ; Female ; Foreign Bodies ; Humans ; Middle Aged ; Ophthalmoplegia ; Optic Nerve ; Orbit* ; Pupil ; Retrobulbar Hemorrhage ; Steel ; Visual Acuity

PURPOSE: To present easily measurable 2D orbit computed tomography (CT) reference data that can be used in a preoperative study for orbital decompression and classification of individual orbital morphologies. METHODS: The study sample was composed of 77 patients with orbital contusion (42 Asian males + 35 Asian females = 154 orbits) who visited the emergency room of the Korea University Guro Hospital from September 2012 to June 2013. Patients with orbital wall fracture, retrobulbar hemorrhage, or eyeball rupture were excluded. Medical records including 2D orbit or facial bone CT were retrospectively reviewed and 4 orbital parameters (orbital length, OL; globe length, GL; GL/OL ratio and 2D cone angle) were measured. RESULTS: The average OL was 42.53 +/- 2.46 mm (35.63-49.09 mm) and average GL was 24.83 +/- 1.09 mm (22.75-28.13 mm). The average GL/OL ratio using these 2 parameters was 0.59 +/- 0.04 (0.50-0.68). The posterior cone angle was on average, 45.96 +/- 5.91degrees (29.35-60.04degrees). CONCLUSIONS: Simple measurement of 4 parameters using 2D orbit CT and classification of Asian individual orbital morphology may help in the choice of the most effective surgical technique for decompression surgery in thyroid eye disease patients.
Asian Continental Ancestry Group ; Classification ; Contusions ; Decompression* ; Emergency Service, Hospital ; Eye Diseases* ; Facial Bones ; Female ; Humans ; Korea ; Male ; Medical Records ; Orbit* ; Retrobulbar Hemorrhage ; Retrospective Studies ; Rupture ; Thyroid Gland*

Retrobulbar hemorrhage is a rare but serious complication after blepharoplasty, mid-face injury, and treatment of facial bone fractures. The incidence of postoperative retrobulbar hemorrhage is 0.055% with an incidence of associated permanent blindness of 0.005%. A 69-year-old male came to the emergency room with pain on both orbital areas and uncontrolled bleeding after cosmetic lower blepharoplasty performed at a private clinic. He had not been evaluated preoperatively by the private clinic, but we found that he had undergone percutaneous transluminal coronary angioplasty and taken anticoagulants for 10 years. We performed an emergency operation to evacuate the hematoma. However, after surgery, he persistently complained of orbital pain, pressure and diminished visual acuity. Intraocular pressure was increased, and computed tomography demonstrated a retrobulbar hemorrhage with globe displacement. Emergent lateral canthotomy and cantholysis were performed. Intraocular pressure was decreased to 48/30 mm Hg immediately after the operation, falling within the normal range the next day. We recommend three points to minimize loss of vision by retrobulbar hematoma. Firstly, careful preoperative evaluation must be conducted including current medications, underlying diseases and previous history of surgeries. Secondly, cautious postoperative observation is important for the early diagnosis of retrobulbar hematoma. Lastly, immediate treatment is crucial to prevent permanent blindness.
Aged ; Angioplasty, Balloon, Coronary ; Anticoagulants ; Blepharoplasty* ; Blindness ; Early Diagnosis ; Emergencies ; Facial Bones ; Hematoma ; Hemorrhage ; Humans ; Incidence ; Intraocular Pressure ; Male ; Orbit ; Reference Values ; Retrobulbar Hemorrhage* ; Vision, Ocular ; Visual Acuity

PURPOSE: To report a case of orbital apex syndrome induced by penetrating orbital injury by a wire with the recovery process and clinical outcomes. CASE SUMMARY: A 40-year-old female visited our clinic after a penetrating orbital injury through the left inferomedial conjunctiva by a wire. The best corrected visual acuity of the left eye was 0.6, and ptosis and total ophthalmoplegia were observed. The patient showed a dilated pupil, swelling of the optic disc on fundus exam, and an inferior field defect on the automated perimetry. The computed tomography image revealed mild retrobulbar hemorrhage, but there was no orbital bony fracture. Enhancement of the optic nerve sheath was observed on the magnetic resonance image. The patient was admitted and received systemic antibiotics and steroid treatment. After 1 month, visual acuity, ptosis, and limitation in adduction were partly improved. After 3 months, depression and adduction were improved and the pupil size was normalized. However, further improvement was not observed after the one-year follow-up. CONCLUSIONS: The recovery from orbital apex syndrome was achieved until 3 months after injury. The final outcomes may depend on the mechanism and pathophysiology of the injury. Emergent diagnosis and proper management are essential to achieve optimal clinical results.
Anti-Bacterial Agents ; Conjunctiva ; Depression ; Eye ; Female ; Humans ; Magnetic Resonance Spectroscopy ; Ophthalmoplegia ; Optic Nerve ; Orbit ; Pupil ; Retrobulbar Hemorrhage ; Visual Acuity ; Visual Field Tests

Retrobulbar hemorrhage, especially when associated with visual loss, is a rare but significant complication after facial bone reconstruction. In this article, two cases of retrobulbar hematoma after surgical repair of blow-out fracture are reported. In one patient, permanent loss of vision was involved, but with the other patient, we were able to prevent this by performing immediate decompression after definite diagnosis. We present our clinical experience with regard to the treatment process and method for prevention of retrobulbar hematoma using a scalp vein set tube and a negative pressure drainage system.
Decompression ; Drainage ; Facial Bones ; Hematoma ; Humans ; Orbit ; Orbital Fractures ; Retrobulbar Hemorrhage ; Scalp ; Veins ; Vision, Ocular

PURPOSE: Retrobulbar hemorrhage is a rare complication followed by blepharoplasty, trauma, orbital reconstruction, and so on. Most of the cases occur within 24 hours, half of them in the first 6 hours. Some authors have reported delayed retrobulbar hemorrhage after blepharoplasty and trauma within 1 day to 9 days. However, there have been few reports of delayed retrobulbar hemorrhage resulting from the complication of orbital reconstruction. METHODS: A 22-year-old male underwent orbital floor reconstruction due to the orbital floor fracture. In 84 hours after the surgery, he complained sudden onset orbital pain and decreased visual acuity immediately after defecation. Intraocular pressure was unmeasurable due to the swelling at that time. Emergency computed tomography was performed. RESULTS: Computed tomography revealed subperiosteal hematoma on inferior orbital wall extended to the apex. Emergency decompressive surgery was performed within 1 hour. After evacuation of hematoma, orbital symptom was improved and visual acuity was restored. CONCLUSION: Delayed retrobulbar hemorrhage is rare but vision-threatening.Therefore early diagnosis and treatment of delayed retrobulbar hemorrhage is thought to be crucial. The cause of delayed hemorrhage was not clear, however, valsalva maneuver might be the cause of hemorrhage.
Blepharoplasty ; Defecation ; Early Diagnosis ; Emergencies ; Floors and Floorcoverings ; Hematoma ; Hemorrhage ; Humans ; Intraocular Pressure ; Male ; Orbit ; Retrobulbar Hemorrhage ; Valsalva Maneuver ; Visual Acuity ; Young Adult

Retrobulbar hemorrhage and permanent visual loss are rare presentations following traumatic asphyxia. In this case, bilateral permanent visual disturbance developed in a woman after chest-crushing trauma without direct trauma to the orbits. A computed tomography scan confirmed bilateral retrobulbar hemorrhages. An ophthalmologic exam revealed bilateral subconjunctival hemorrhages and severe lid edema. Despite high-dose steroid therapy, visual recovery was limited, and optic nerve atrophy developed. Ischemia of the optic nerve associated with retrobulbar hemorrhage may be postulated as one of the causes of permanent visual impairment following traumatic asphyxia.
Asphyxia/*complications/*etiology ; Female ; Humans ; Ischemia/complications ; Middle Aged ; Optic Nerve/blood supply ; Retrobulbar Hemorrhage/*complications/*etiology/radiography ; Thoracic Injuries/*complications ; Tomography, X-Ray Computed ; Vision Disorders/*etiology

PURPOSE: Blunt trauma can cause a wide range of ocular injuries. This study was performed to describe the prevalence of severe intraocular injuries (SIOI) and their correlation with the severity of blunt orbital trauma. METHODS: We retrospectively analyzed 117 eyes of 107 patients with orbital wall fractures who visited the emergency room at Konyang University Hospital from July 2006 to June 2008. Clinical features such as age, sex, causes of injury, revised trauma score (RTS), type of orbital wall fractures were recorded. The patients were divided into two groups: blowout fracture with severe intraocular injuries (SIOI) and blowout fracture without SIOI. We compared the clinical and the injury-related characteristics between two groups and analyzed the SIOS-related factors. RESULTS: Among the 107 patients (117 eyes) with blowout fractures, 29 (27.1%) patients with 32 eyes (25.6%) had complicated severe intraocular injuries. Retrobulbar hemorrhage (14.5%), hyphema (13.7%), traumatic optic nerve injury (4.3%), and sustained loss of visual acuity (4.3%) were the most common SIOI disorders. A logistic regression analysis revealed that loss of visual acuity (odds ratio = 4.75) and eyeball motility disorder (odds ratio=7.61) were significantly associated with SIOS. CONCLUSION: We suggest that blowout fracture patients with loss of visual acuity or eyeball motility disorder are mostly likely to have severe intraocular injuries, so they need an ophthalmologic evaluation immediately.
Emergencies ; Eye ; Eye Injuries ; Humans ; Hyphema ; Logistic Models ; Optic Nerve Injuries ; Orbit ; Orbital Fractures ; Prevalence ; Retrobulbar Hemorrhage ; Retrospective Studies ; Visual Acuity

PURPOSE: There have been no reports of optic nerve injuries caused by gunshot in Korea. We describe such an injury and report the treatment outcomes. CASE SUMMARY: A patient visited our hospital complaining of visual disturbance after her right zygomatic bone had been shot with an airgun during a suicide attempt in September 2006. A visual acuity test, pupillary light reflex test, fundus examination, skull X-ray, and computed tomography (CT) were performed. At the initial examination, the right eye had no light perception. The pupillary light reflex test revealed an afferent pupillary defect, and the fundus examination showed central retinal artery occlusion. The skull X-ray and computed tomography revealed a fracture of the right medial and lateral orbital walls as well as a partial injury to the medial rectus muscle. In addition, right retrobulbar hemorrhage and metallic foreign bodies were observed in the right orbit. Under general anesthesia, disinsertion of the superior and lateral rectus muscles was performed, and the metallic foreign bodies in the right orbit were removed. The surgical incision was then closed. A Krimsky prism test performed 7 days after surgery revealed an approximately 15 prism diopters of exodeviation of the right eye. CONCLUSIONS: We report a case of optic nerve injury caused by a gunshot.
Anesthesia, General ; Exotropia ; Eye ; Foreign Bodies ; Humans ; Korea ; Light ; Muscles ; Optic Nerve ; Optic Nerve Injuries ; Orbit ; Pupil Disorders ; Reflex ; Retinal Artery Occlusion ; Retrobulbar Hemorrhage ; Skull ; Suicide ; Visual Acuity