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Which bleed is this shown in image near the left eye

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Reading File
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Finding Sources
Reading File
Based on my careful review of the CT image and the medical literature, here is the answer:

Retrobulbar Hemorrhage (Orbital Compartment Bleed)

Looking at this axial CT brain slice at the level of the orbits, there is increased density (whitish/hyperdense signal) within the retrobulbar/intraconal fat space of the left orbit - the area behind the left eyeball. This is consistent with a retrobulbar hemorrhage (also called retrobulbar hematoma).

What you're seeing on CT:

On a normal CT, the fat behind the eyeball appears uniformly dark/black. In retrobulbar hemorrhage, this fat space shows:
  • Increased reticular (mesh-like) whitish density replacing the normally dark retrobulbar fat
  • Possible "tenting" or teardrop distortion of the posterior globe if pressure is high

Key CT findings of retrobulbar hemorrhage:

  • CT rarely shows a discrete, well-defined hematoma
  • More typically: diffuse increased reticular pattern of the intraconal orbital fat
  • The "teardrop/tenting sign" - optic nerve at maximum stretch distorting the back of the globe into a teardrop shape - is an ominous sign (posterior scleral angle <130° is concerning)

Clinical relevance:

Retrobulbar hemorrhage can cause Orbital Compartment Syndrome (OCS) - a vision-threatening emergency. Signs include:
  • Proptosis (eye bulging)
  • Raised intraocular pressure
  • Afferent pupillary defect
  • Subconjunctival hemorrhage
It can be traumatic, postoperative (after orbital/sinus surgery), or spontaneous (in anticoagulated patients or coagulopathies).
Treatment when OCS is present: Immediate lateral canthotomy and inferior cantholysis - this is a clinical diagnosis and should NOT be delayed for CT imaging if vision is threatened.
  • The Wills Eye Manual, p. 115-116
Disclaimer: This interpretation is based on a single CT slice from a photo. A complete radiological assessment by a qualified radiologist reviewing the full series at full resolution, combined with the patient's clinical history, is essential for any clinical decision-making.
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