Background and objectives: Retrobulbar haemorrhage is an uncommon, but potentially devastating complication associated with facial trauma. The rapid increase in orbital pressure can cut off perfusion to vital ocular structures, leading to intermittent or in more severe cases permanent visual loss. The cardinal signs and symptoms of retrobulbar haematoma are pain, diplopia, ophthalmoplegia, a progression of increasing proptosis, and decreasing visual acuity that may lead to blindness.

Methods: We report a case of a 35 years old men with protptosis, ophtalmoplegia and complete vision lost of the left eye, after being assaulted. Pathology off the eye ball was excluded by an ophthalmologist. The CT scan showed left multiple orbital fractures of the floor and internal wall, retrobulbar haemorrhage and optic nerve stretching. He underwent an emergency procedure with drainage of the haematoma and reconstruction of the orbit with a titanium plate, trough an infraorbital approach. Steroid therapy was also promptly started.

Results: 2 days after the surgery the patient started to recovery eye movements and light perception. 1 month after surgery the patient has a 2/10 visual acuity, still maintaining diplopia in upper gaze.

Conclusions: In severe acute retrobulbar haemorrhage, prompt surgical evacuation of the haematoma can reverse visual loss.