What is the first-line treatment for retrobulbar haemorrhage?

The first-line treatment for retrobulbar hemorrhage primarily focuses on addressing the urgent need to relieve pressure within the orbit to prevent optic nerve damage and other complications. Mannitol, acetazolamide, and dexamethasone are used collectively to manage this condition effectively.

Mannitol is an osmotic diuretic that helps reduce intraocular pressure by drawing fluid out of the orbit and into the bloodstream, thereby alleviating the pressure on the optic nerve. Acetazolamide, a carbonic anhydrase inhibitor, aids in decreasing the production of ocular fluid, which further assists in lowering intraocular pressure. Dexamethasone, a corticosteroid, helps reduce inflammation and can assist in managing any associated tissue swelling or pressure, supporting the healing process and protecting visual function.

This combination of medications provides a multi-faceted approach to treat the condition while minimizing the risk of long-term visual impairment. In cases where conservative management is insufficient, surgical intervention for drainage may be warranted, but it is not the immediate first-line treatment.

The other options, while they may have roles in managing other conditions or provide supportive care, do not address the urgency of pressure relief that is critical in retrobulbar hemorrhage.