Retrobulbar haemorrhage: when should we operate?

Retrobulbar haemorrhage (RBH) is the most common complication of retrobulbar anaesthesia. Following such haemorrhage the patient is traditionally discharged from hospital the following day and readmitted a month or so later to undergo surgery, preferably under general anaesthesia. Such a practice no doubt causes anxiety and disappointment for both the surgeon and the patient. This retrospective study was based at Victoria Hospital, Kirkcaldy, where most of the patients who develop RBH have repeat surgery under general anaesthesia or, if not suitable, under local anaesthesia within 2-4 days of the incident. The study showed that if certain guidelines are followed, then it is quite safe to proceed with planned surgery soon after the haemorrhage and that long postponement is not necessary.