This is a case of Retrobulbar hemorrhage made this ppt for case presentation competiation in my college

2. Name: Gogu.Nagamani
Age: 50 years
Sex: Female
Occupation: House wife
W/O: Prakash Rao
Resident: Peddevam village
Date of admission: 14th April 2014
Chief Compliants: Redness in Left Eye from
1 day

3. History of Present illness:
 Redness in Left Eye from 1 day
 Onset – Gradual
 progressive in nature
No history of – Trauma,
Itching,
Pain,
Watering,
Photophobia,
Fever.

4. 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

5. General Physical Examination
 Moderate built
 Gross pallor present
 No cyanosis
 No clubbing
 No edema feet
 No jaundice
Vitals
BP -130/70 mm of Hg
PR-82 beats /minute
RR-20 breaths/min
Temp - Afibrile

6. Ocualr Examination
Head posture – normal
Forehead – normal
Facial symmetry – Maintained

7. Right Eye
Visual acuity – 6/18 with pin hole 6/12
Orbit – Margins intact
Eyeballs – normal size and position
Extra ocular movements – Full and Free
Eyelids – Normal
Conjunctiva – No congestion/ No
discharge
Sclera – No nodules/ectasia
Tear Film – 15mm(by schirmer’s test)

9. Cornea – clear
Corneal sensations – intact
Anterior chamber – normal depth
optically clear
Iris – Brown with
normal pattern
Pupil – Round ,
central ,
2.5mm,
Direct light reflex normal

10. Lens – Grayish white opacity is present
Intra ocular pressure – 14.6mm of Hg
Drainage System – Punta well appososed
Regurgitation test is negative

11. Left eye
Visual acuity – 6/18 with pin hole 6/18
Orbit – Margins intact
Eyeballs – Normal size and position
Extra ocular movements – Full and Free
Eyelids – Normal
Conjunctiva – Flat sheet of
Haemorrhage which is dark red in
colour in nasal bulbar conjunctiva ,
posterior limit is not seen, Fornixceal
conjunctiva is intact

12. Foxniceal conjunctiva
is in tact
Flat sheet of
Haemorrhage which is
dark red in colour in nasal
bulbar conjunctiva

13. Sclera – no nodule and
no ectasia
Tear Film – 15 mm ( by schirmer’s test)
Cornea – clear
Corneal sensations – intact
Anterior chamber – normal depth
optically clear
Iris – Brown with normal pattern

14. Pupil – Round,
Central,
2.5mm
Direct light reflex is normal
Lens – lens is normal with Grayish white
opacity
Intraocular pressure – 14.6 mm of Hg
Drainage system – Punta well apposed
Regurgitation test is negative

15. Provisional Diagnosis
A 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

16. Differential diagnosis
1.Subconjunctival hemorrhage
2.Conjunctivities
3.Iritis
4.Episcleritis
5.Scleritis
6.Keratitis
7.Acute angle closure glaucoma

17. Test 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

18. 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

19. 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

20. ECG - Normal

21. Summary
Clinical findings
1.Flat sheet of haemorrhage which is dark red.
2. posterior limit is not seen
3.Fornixceal conjunctiva is intact
4.Pallor
Laboratory findings
1.Thrombocytopenia
2.Anemia
3.Type 2 Diabetes mellitus

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

23.  Conservative(Retro bulbar hemorrhage
absorbs spontaneously)
1. Thorough inspection for every one hour
2. 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
.

24. Complications
 Proptosis
 Optic nerve compression

25. THANK YOU

26. Retro 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

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