Case report: bilateral retrobulbar hemorrhage and vision loss following traumatic asphyxia

The authors report the case of a 47-year-old woman who experienced bilateral retrobulbar hemorrhages and permanent vision loss due to traumatic asphyxia that occurred when she was pinned between a conveyer belt and car body while working in a car manufacturing plant. An ophthalmologic exam in the hospital following the accident revealed bilateral subconjunctival hemorrhages and severe lid edema. Computed tomography (CT) scans of the orbit demonstrated bilateral retrobulbar hemorrhages, mild proptosis and severe eyelid swelling. The authors conclude that ischemia of the optic nerve associated with retrobulbar hemorrhage may be one of the causes of permanent visual impairment following traumatic asphyxia.

During the accident, the patient's left shoulder and chest were compressed more for more than 20 minutes before she was released. Upon arriving at the emergency department, she was still unconscious, with facial cyanosis, severe edema and petechiae. Radiographs and CT scans of her chest, abdomen and head revealed bilateral pneuomothoraces, hemothoraces, multiple rib fractures and a left scapular fracture. Her blood pressure was unstable, with no other signs or history of head injury.

Despite subsequent high-dose steroid therapy, visual recovery was limited, and the patient developed optic nerve atrophy. The authors say that even though the amount of hemorrhage was small, optic nerve ischemia could have been aggravated by a combination of the relatively long duration of compression, inadequate ventilation, arterial hypotension and venous hypertension. They say that intracranial and retinal hemorrhages have been surprisingly infrequent in traumatic traumatic asphyxia patients, with the prognosis for vision usually good and vision loss temporary.

The authors recommend the performance and documentation of a complete ophthalmologic exam in traumatic asphyxia cases. They say that this is particularly important in patients who may inaccurately report visual impairment, such as children and those with prolonged unconsciousness, including intubated patients with retrobulbar hemorrhage.