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Management of acute retrobulbar haemorrhage: a survey of non-ophthalmic emergency department physicians
  1. Matthew R Edmunds1,
  2. Anjana S Haridas1,
  3. Daniel S Morris1,
  4. Kasyap Jamalapuram2
  1. 1 Cardiff Eye Unit, University Hospital of Wales, Cardiff, UK
  2. 2 Emergency Department, Birmingham Children’s Hospital, Birmingham, UK
  1. Correspondence to Dr Matthew R Edmunds, Cardiff Eye Unit, University Hospital of Wales, Heath Park Way, Cardiff CF14 4XW, UK; matthew.r.edmunds{at}nhs.net

Abstract

Introduction Acute retrobulbar haemorrhage (RBH) with orbital compartment syndrome is a sight-threatening ophthalmic emergency requiring treatment with lateral canthotomy and cantholysis (LC/C). However, such cases may present to non-ophthalmic emergency departments (ED) out-of-hours, when specialist intervention is not readily available. We completed a survey of ED physicians to explore experiences of RBH and confidence in undertaking LC/C.

Methods From February to April 2018, an online survey was sent to ED physicians of all training grades in seven UK locations. The survey comprised a case vignette of a patient presenting with clinical features of RBH with orbital compartment syndrome, with multiple choice questions on the diagnosis, management and onward referral of such cases. Additional questions explored the experience of RBH, LC/C and perspectives on current and future training of ED physicians in this area.

Results 190 ED doctors completed the survey (response rate 70%). While 82.8% correctly diagnosed RBH and 95.7% recognised irreversible visual loss as a consequence of untreated RBH with orbital compartment syndrome, 78.7% indicated that they would initially undertake CT imaging rather than performing LC/C. Only 38.9% had previously encountered a case of RBH and only 37.1% would perform LC/C themselves, with 91.4% indicating that this was due to lack of training. 92.2% felt that more training was required for ED physicians in RBH management and performing LC/C.

Conclusion While cases of RBH with orbital compartment syndrome are infrequent, it is important that RBH management with the vital, sight-saving skill of LC/C is added to the United Kingdom Royal College of Emergency Medicine training curriculum. At present, though the majority of ED physicians can identify RBH, the minority are willing or able to undertake LC/C, potentially risking irreversible but avoidable visual loss.

  • retrobulbar haemorrhage
  • compartment syndrome
  • lateral canthotomy

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Footnotes

  • Contributors MRE: conception and design, acquisition, analysis and interpretation of data for the work, drafting the work and revising it critically for important intellectual content; and final approval of the version to be published. ASH and DSM: analysis and interpretation of data for the work, drafting the work and revising it critically for important intellectual content; and final approval of the version to be published. KJ: design, analysis and interpretation of data for the work, drafting the work and revising it critically for important intellectual content; and final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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