retrobulbar hemorrhage by somu venkatesh

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Retrobulbar Hemorrhage By Somu Venkatesh Final Year Part-1

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Page 1: Retrobulbar hemorrhage by Somu Venkatesh

Retrobulbar Hemorrhage

By Somu VenkateshFinal Year Part-1

Page 2: Retrobulbar hemorrhage by Somu Venkatesh

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

Page 3: Retrobulbar hemorrhage by Somu Venkatesh

History of Present illness: Redness in Left Eye from 1 day Onset – Gradual progressive in natureNo history of – Trauma, Itching, Pain, Watering, Photophobia, Fever.

Page 4: Retrobulbar hemorrhage by Somu Venkatesh

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

Page 5: Retrobulbar hemorrhage by Somu Venkatesh

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

Page 6: Retrobulbar hemorrhage by Somu Venkatesh

Ocualr ExaminationHead posture – normal

Forehead – normalFacial symmetry – Maintained

Page 7: Retrobulbar hemorrhage by Somu Venkatesh

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)

Page 8: Retrobulbar hemorrhage by Somu Venkatesh

Right Eye

Page 9: Retrobulbar hemorrhage by Somu Venkatesh

Cornea – clearCorneal sensations – intactAnterior chamber – normal depth optically clearIris – Brown with normal patternPupil – Round , central , 2.5mm, Direct light reflex normal

Page 10: Retrobulbar hemorrhage by Somu Venkatesh

Lens – Grayish white opacity is presentIntra ocular pressure – 14.6mm of HgDrainage System – Punta well

appososed Regurgitation test is

negative

Page 11: Retrobulbar hemorrhage by Somu Venkatesh

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

Page 12: Retrobulbar hemorrhage by Somu Venkatesh

Foxniceal conjunctiva is in

tact

Flat sheet of Haemorrhage which is dark red in colour in

nasal bulbar conjunctiva

Page 13: Retrobulbar hemorrhage by Somu Venkatesh

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

Page 14: Retrobulbar hemorrhage by Somu Venkatesh

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

Page 15: Retrobulbar hemorrhage by Somu Venkatesh

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

Page 16: Retrobulbar hemorrhage by Somu Venkatesh

Differential diagnosis1.Subconjunctival hemorrhage2.Conjunctivities3.Iritis4.Episcleritis5.Scleritis6.Keratitis7.Acute angle closure glaucoma

Page 17: Retrobulbar hemorrhage by Somu Venkatesh

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

Page 18: Retrobulbar hemorrhage by Somu Venkatesh

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

Page 19: Retrobulbar hemorrhage by Somu Venkatesh

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

Page 20: Retrobulbar hemorrhage by Somu Venkatesh

ECG - Normal

Page 21: Retrobulbar hemorrhage by Somu Venkatesh

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

Page 22: Retrobulbar hemorrhage by Somu Venkatesh

DIAGNOSIS

Retrobulbar hemorrhage in Left Eye which is spontaneous onset due to anemia , thrombocytopenia and Type 2 Diabetes Milletus

Page 23: Retrobulbar hemorrhage by Somu Venkatesh

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

.

Page 24: Retrobulbar hemorrhage by Somu Venkatesh

Complications Proptosis Optic nerve compression

Page 25: Retrobulbar hemorrhage by Somu Venkatesh

THANK YOU

Page 26: Retrobulbar hemorrhage by Somu Venkatesh

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

Page 27: Retrobulbar hemorrhage by Somu Venkatesh

Platelet count >60,000 – no bleeding 30000- 60,000 – bleeding with trauma <30,000 – spontaneous bleeding

Page 28: Retrobulbar hemorrhage by Somu Venkatesh