Retrobulbar hemorrhage after tenecteplase thrombolysis for acute stroke following strabismus surgery

Ocular and orbital hemorrhage are rare but serious complications of thrombolytic therapy. We present the case of an 83-year-old woman who developed a retrobulbar hemorrhage resulting in left orbital compartment syndrome following tenecteplase thrombolysis for acute ischemic stroke shortly after uncomplicated bilateral strabismus surgery. The patient underwent lateral canthotomy with inferior and superior cantholysis for intraocular pressure reduction. Hemostasis was achieved after the use of topical thrombin-gelatin and thrombolytic reversal with cryoprecipitate and platelets. To our knowledge, this is the first reported case of retrobulbar hemorrhage after tenecteplase thrombolysis for acute ischemic stroke following strabismus surgery.