Acute proptosis in trauma: retrobulbar hemorrhage or orbital compartment syndrome--does it really matter?

To review the nature and outcomes of acute severe proptosis in patients after craniofacial trauma, over a 6-year period.

These were identified prospectively. The mechanism of injury, nature of the proptosis, and visual outcomes in each case were reviewed. Review of the literature was undertaken.

In all cases proptosis, was secondary to retrobulbar edema and not hemorrhage.

Many cases of "retrobulbar hemorrhage" may, in fact, be secondary to edema. This has significant implications when managing the proptosed eye on an emergent basis. Possible reasons for poor outcomes are discussed. A number of unanswered questions arise from this review.