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The “guitar pick” sign: a novel sign of retrobulbar hemorrhage

  • Jonathan Theoret (a1) (a2), Geoffrey E. Sanz (a1) (a3), David Matero (a4), Todd Guth (a1), Catherine Erickson (a1), Michael M. Liao (a1) and John L. Kendall (a1)...

Abstract

Retrobulbar hemorrhage is a rare complication of blunt ocular trauma. Without prompt intervention, permanent reduction in visual acuity can develop in as little as 90 minutes. We report a novel bedside ultrasound finding of conical deformation of the posterior ocular globe: the “guitar pick” sign. In our elderly patient, the ocular globe shape normalized post–lateral canthotomy and inferior cantholysis. Identifying this sonographic finding may add to the clinical examination when deciding whether to perform decompression.

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Copyright

Corresponding author

Denver Health and Hospital Authority, 777 Bannock Street, Denver, CO 80204; John.Kendall@dhha.org.

References

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1.Hislop, WS, Dutton, GN, Douglas, PS. Treatment of retrobulbar haemorrhage in accident and emergency departments. Br J Oral Maxillofac Surg 1996;34:289–92, doi:10.1016/S0266-4356(96)90004-2.
2.Rosdeutscher, JD, Stadelmann, WK. Diagnosis and treatment of retrobulbar hematoma resulting from blunt periorbital trauma. Ann Plast Surg 1998;41:618–22, doi:10.1097/00000637-199812000-00006.
3.Shek, KC, Chung, KL, Kam, CW, et al. Acute retrobulbar haemorrhage: an ophthalmic emergency. Emerg Med Australas 2006;18:299–301, doi:10.1111/j.1742-6723.2006.00857.x.
4.Blaivas, M. Bedside emergency department ultrasonography in the evaluation of ocular pathology. Acad Emerg Med 2000;7:947–50, doi:10.1111/j.1553-2712.2000.tb02080.x.

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