ESCRS - PO082 - Medical Management Of Traumatic Non-Axial Proptosis Due To Retrobulbar Hematoma In A 15-Year-Old Sudanese Child

Medical Management Of Traumatic Non-Axial Proptosis Due To Retrobulbar Hematoma In A 15-Year-Old Sudanese Child

Published 2025 - 43rd Congress of the ESCRS

Reference: PO082 | Type: Case Report | DOI: 10.82333/td40-yc36

Authors: Doaa Salah Addin Grew* ¹

¹ophthalmology department,Benghazi eye hospital,Benghazi,Libya

Purpose

This case report describes a 15-year-old Sudanese male who developed traumatic retrobulbar hematoma with delayed non-axial proptosis following blunt orbital trauma. It details the clinical findings, diagnostic imaging, and the rationale for a conservative treatment approach using tranexamic acid and corticosteroids, given the absence of optic nerve compression. The report underscores the value of early diagnosis, appropriate imaging, and vigilant monitoring in managing traumatic retrobulbar hemorrhage non-surgically to prevent complications and achieve favorable outcomes

Setting

This case was managed at Benghazi Eye Hospital, a tertiary care center in Libya with specialized ophthalmologic services. A 15-year-old Sudanese male with blunt orbital trauma was diagnosed with retrobulbar hematoma without fractures or optic nerve compression. The hospital’s facilities enabled close monitoring and treatment adjustments. A multidisciplinary team provided comprehensive care from Day 1 through follow-ups on Days 4 and 8, ensuring timely management based on the patient’s progress.

Report of case

A 15-year-old Sudanese male presented with progressive left-eye proptosis following blunt orbital trauma. Examination revealed non-axial proptosis with limited ocular motility but no pain or vision loss. A CT scan confirmed a retrobulbar hematoma without fractures or optic nerve compression. Initial conservative treatment included tranexamic acid, vitamin C, lubricating gel, and eye patching. By day 4, symptoms persisted, prompting intravenous corticosteroids, followed by oral steroids and tranexamic acid. By day 8, the patient showed marked improvement in proptosis and motility, with no complications, highlighting the effectiveness of a non-surgical approach in selected cases

Conclusion/Take home message

Traumatic retrobulbar hematoma (RBH) results from vascular injury, causing blood accumulation and increased intraorbital pressure. While severe cases require surgery, conservative management with antifibrinolytics and corticosteroids can be effective. In this case, tranexamic acid stabilized the hematoma, and corticosteroids reduced inflammation, leading to resolution of proptosis. The absence of optic nerve compression supported a non-surgical approach. Early diagnosis, CT imaging, and close monitoring are essential to prevent complications. Conservative treatment can be successful, avoiding surgery while ensuring favorable outcomes.