Question

42 year-old male s/p assault complains of right sided facial pain, swelling, and decreased vision. Physical exam reveals subconjunctival hemorrhage, proptosis, afferent pupillary defect, and a firm globe. What's the diagnosis and what's the emergent treatment?

Answer

• Retrobulbar hematoma (a compartment syndrome of the eye) with proptosis.
• Treatment is emergent lateral canthotomy; lowering intraocular pressure with medical therapy (e.g., steroids, mannitol, etc.) is a temporizing option but should never delay canthotomy. 
• Here's a video narrated by our own Dr. Mak Moayedi demonstrating the procedure.

References

Follow me on Twitter (@criticalcarenow) or Google+ (+criticalcarenow)