retrobulbar hemorrhage by somu venkatesh
TRANSCRIPT
Retrobulbar Hemorrhage
By Somu VenkateshFinal Year Part-1
Name: Gogu.NagamaniAge: 50 yearsSex: FemaleOccupation: House wifeW/O: Prakash RaoResident: Peddevam villageDate of admission: 14th April 2014Chief Compliants: Redness in Left Eye
from 1 day
History of Present illness: Redness in Left Eye from 1 day Onset – Gradual progressive in natureNo history of – Trauma, Itching, Pain, Watering, Photophobia, Fever.
History of Past illness: Similar compliant 6 months back. No history of allergy, diabetes millets,
hypertension, tuberculosis, asthma, cardiac diseases, renal abnormalities and long standing systemic illnesses.
No history of medication. Menstrual history: menopause – 10 years
back
Family history No family history related to present illness. No family history of diabetes mellitus, hypertension
General Physical Examination Moderate built Gross pallor present No cyanosis No clubbing No edema feet No jaundice
VitalsBP -130/70 mm of HgPR-82 beats /minute
RR-20 breaths/minTemp - Afibrile
Ocualr ExaminationHead posture – normal
Forehead – normalFacial symmetry – Maintained
Right EyeVisual acuity – 6/18 with pin hole 6/12Orbit – Margins intactEyeballs – normal size and positionExtra ocular movements – Full and FreeEyelids – NormalConjunctiva – No congestion/ No
dischargeSclera – No nodules/ectasiaTear Film – 15mm(by schirmer’s test)
Right Eye
Cornea – clearCorneal sensations – intactAnterior chamber – normal depth optically clearIris – Brown with normal patternPupil – Round , central , 2.5mm, Direct light reflex normal
Lens – Grayish white opacity is presentIntra ocular pressure – 14.6mm of HgDrainage System – Punta well
appososed Regurgitation test is
negative
Left eyeVisual acuity – 6/18 with pin hole 6/18Orbit – Margins intactEyeballs – Normal size and positionExtra ocular movements – Full and Free Eyelids – NormalConjunctiva – Flat sheet of Haemorrhage
which is dark red in colour in nasal bulbar conjunctiva , posterior limit is not seen, Fornixceal conjunctiva is intact
Foxniceal conjunctiva is in
tact
Flat sheet of Haemorrhage which is dark red in colour in
nasal bulbar conjunctiva
Sclera – no nodule and no ectasiaTear Film – 15 mm ( by schirmer’s test)Cornea – clearCorneal sensations – intactAnterior chamber – normal depth optically clearIris – Brown with normal pattern
Pupil – Round, Central, 2.5mm Direct light reflex is normalLens – lens is normal with Grayish
white opacityIntraocular pressure – 14.6 mm of HgDrainage system – Punta well apposed Regurgitation test is
negative
Provisional DiagnosisA 50 year female presented with flat sheet of
haemorrhage which is dark red in colour in nasal bulbar conjunctiva in left eye, whose posterior limit is not seen and fornixceal conjunctiva is intact and also presenting with pallor may be suffering with retro bulbar haemorrhage may be due to anaemia
Differential diagnosis1.Subconjunctival hemorrhage2.Conjunctivities3.Iritis4.Episcleritis5.Scleritis6.Keratitis7.Acute angle closure glaucoma
InvestigationsTest Test value Normal value
Hb 8.8 13 to 15 gm/dl
RBS 315 140 to 200 mg/dl
TOTAL WBC 7,800 4,ooo to 11,000cells /mm3
PLATELET COUNT 18,0000 2 to 5 lakhs/mm3
BT 2min 10 sec 2 to 7 min
CT 4 min 6 sec 4 to 9 min
BLOOD BIOCHEMICAL
TEST
TEST VALUES NORMAL VALUES
GLUCOSE:PPBS 383 140 to 200 mg/dl
UREA 16 20 to 40 mg/dl,
CREATININE 1.4 0.5 to 1.2mg/dl
SODIUM 136 135 to 145mEq/L
POTASSIUM 3.7 3.5 to 5mEq/L
PATHOLOGICAL TEST
TEST VALUES NORMAL VALUES
HEAMGLOBIN 8.8 13 to 15 gm/dl
TOTAL WBC COUNT 7800 4,ooo to 11,000cells /mm3
DIFFERENTIAL COUNT
NEUTROPHILS 64 40-75%
LYMPHOCYTES 32 20-50%
EOSINOPHILS 1 1-6%
PLATELET COUNT 18,000 2 to 5 lakhs/mm3
ECG - Normal
SummaryClinical findings1.Flat sheet of haemorrhage which is dark red.2. posterior limit is not seen 3.Fornixceal conjunctiva is intact4.PallorLaboratory findings1.Thrombocytopenia2.Anemia3.Type 2 Diabetes mellitus
DIAGNOSIS
Retrobulbar hemorrhage in Left Eye which is spontaneous onset due to anemia , thrombocytopenia and Type 2 Diabetes Milletus
MANAGEMENT
Conservative(Retro bulbar hemorrhage absorbs spontaneously)
1. Thorough inspection for every one hour2. Cleaning 3. Repair of wounds and 4. Cold compresses followed by warm compresses.
Etiological factors (Anemia, Thrombocytopenia, and Type 2 Diabetes Miletus) are treated accordingly
.
Complications Proptosis Optic nerve compression
THANK YOU
DiscussionRetro bulbar Hemorrhage Subconjunctival
Hemorrhage
Gradual in onset(24 hrs) Sudden in onset
Dark colour due to alter colour of Blood
Bright red in colour
Posterior margin is not seen All margins are well defined
Slight proptosis may be present if retro bulbar hemorrhage is more.
Eye is in normal position
Absorption occurs within few weeks
Absorption occurs within few days
Complications can occur like Protosis and Compression of optic nerve
No other associated complications are present
Platelet count >60,000 – no bleeding 30000- 60,000 – bleeding with trauma <30,000 – spontaneous bleeding