Retrobulbar hemorrhage (RBH) is a rare but potentially devastating complication that can lead to permanent vision loss. Prompt identification and appropriate intervention are critical to avoid irreversible blindness. Practitioners are aware of the potential development of RBH secondary to orbital floor reconstruction, blepharoplasty, and endoscopic sinus surgery, however, rarely due to dental procedures. In this case report, we present RBH resulting following upper wisdom tooth extraction and to review the possible anatomical pathway underlying this complication.
RBH could develop from orbital floor reconstruction, blepharoplasty, endoscopic sinus surgery, and dental extraction.
Awareness about rare complications is essential knowledge for common procedures such as dental extraction.
Early identification and appropriate intervention are critical to avoid irreversible blindness.
Retrobulbar hemorrhage (RBH) is an infrequent orbital complication with potential sight-threatening sequela. Vision loss can result either from direct hypoperfusion to the optic nerve or compression and stasis of the central retinal vasculature that could lead to permanent neuropathy [ ]. The etiology of orbital hematoma classified as traumatic, iatrogenic, or spontaneous. Iatrogenically, several procedures can cause RBH such as endoscopic sinus surgery, blepharoplasty, retrobulbar injections, or reconstructive trauma surgery [ ]. Early recognition, accurate diagnosis, and prompt management of retrobulbar hemorrhage are essential to prevent irreversible blindness. The aim of this case report is to describe a unique case of RBH following upper wisdom tooth extraction and demonstrate the probable anatomical correlation.
A 27-year-old healthy woman presented to the Oral and Maxillofacial Surgery outpatient clinic at the Montreal General Hospital 2 h after having her upper left wisdom tooth extracted by a general dentist ( Fig. 1 ). She complained of pain, intermittent blurriness, and double vision following the extraction.
Clinical examination revealed a firm swelling of the patient’s left cheek, left periorbital ecchymosis, left subconjunctival hemorrhage, and significant proptosis of the left orbit ( Fig. 2 ). Her pupils were equal and reactive to light and accommodation. The remainder of the face and neck physical exam was unremarkable. An ophthalmology team performed a comprehensive orbital exam, which confirmed a mild decrease in visual acuity in the left eye (VA20/25) with diplopia, mildly elevated intraocular pressure (23 mmHg), and exophthalmometry measuring 29 mm of the left orbit (OD 20 mm).
Based on the clinical presentation, an urgent computed tomography (CT) scan was obtained. The CT scan showed significant subcutaneous emphysema involving the left masticator space, which extended to the left eye through the inferior orbital fissure. The scan also revealed a 1.3 × 1.3 cm extraconal hematoma causing minimal mass effect on the inferior and lateral rectus muscles ( Fig. 3 ).