Traumatic retrobulbar hematoma: a European multicenter study

Background: Retrobulbar hematoma/hemorrhage (RBH) is a vision-threatening condition requiring prompt diagnosis and timely medical or surgical intervention. Despite its clinical relevance, standardized treatment protocols and well-defined prognostic factors remain lacking. Materials and methods: This retrospective multicenter study included patients treated for posttraumatic RBH between January 2015 and December 2024. Demographic data, comorbidities, antithrombotic therapy, trauma etiology, associated injuries, clinical signs, imaging findings, treatment modalities, and visual outcomes were recorded. Outcomes were classified as complete visual recovery, partial recovery, or blindness. Results: In total, 77 patients (mean age 56 years) were included. Falls were the most common cause of injury, with concomitant body injuries present in 61% of patients and associated ocular injuries in 22%. Computed tomography was the primary imaging modality. RBH was extraconal in most cases, while intraconal involvement was less frequent. Most patients received combined medical and surgical treatment, with lateral canthotomy and cantholysis being the most common surgical approach. Complete visual recovery occurred in 51.9% of patients, partial recovery in 29.9%, and blindness in 10.4%. Intraconal RBH and associated ocular injury were significantly associated with poorer visual outcomes, whereas age, hematoma size, treatment type, timing of intervention, and antithrombotic therapy were not. Conclusions: RBH is a rare maxillofacial trauma entity that often results in permanent disability. Intraconal localization and concomitant ocular injury are significant predictors of poor prognosis. Early recognition and individualized management are essential to optimize visual outcomes.