A simplified technique of orbital decompression for severe retrobulbar hemorrhage

Severe retrobulbar hemorrhage may occur as a complication of a retrobulbar injection or from blunt or sharp injury to the orbit during an orbital or periorbital operation. When the patient with a severe retrobulbar hemorrhage does not respond to intermittent ocular massage, or paracentesis, or a lateral canthotomy, prompt orbital decompression becomes necessary. A simple and effective surgical technique that is applicable in such urgent situations was used in this study. The procedure does not entail waiting for computed tomography or the availability of an orbital surgeon and requires only minimal local anesthetics. A small mosquito clamp is inserted into the orbit through a small opening in the inferior fornix. The clamp is advanced into the orbit along the medial orbital floor until a depth of about 20 mm is reached. Pressure is applied to the clamp to break the orbital floor and maxillary sinus mucosa, and to decompress the orbit. I successfully used this technique on five patients in the past five years.