Recurrent Retrobulbar Hemorrhage Associated with CPAP Use after Orbital Fracture Repair

Christine Ryu, Katie Geelan-Hansen, Rao V. Chundury

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


We present a patient who underwent orbital fracture repair complicated by retrobulbar hemorrhages twice within the first postoperative week. The suspected cause is continuous positive airway pressure (CPAP) use with inappropriate patient-modified settings. The most likely mechanism of action was venous congestion from the extrinsic positive pressure, similar to Valsalva maneuvers increasing orbital vasculature pressure. In our patient, because his orbital blood vessels had recently been cauterized, they were too fragile to handle the engorgement and bled, leading to a retrobulbar hemorrhage. It is possible that at a lower CPAP setting, the vascular congestion would not have been as severe and caused bleeding. We recommend routinely asking patients about CPAP use before orbital surgeries and instructing patients to stop CPAP usage for 1 week after any orbital surgeries if medically cleared.

Original languageEnglish (US)
Pages (from-to)E122-E124
JournalOphthalmic Plastic and Reconstructive Surgery
Issue number4
StatePublished - Jul 1 2022

ASJC Scopus subject areas

  • Surgery
  • Ophthalmology


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