Endovascular Management of Uncontrollable Orbital Hemorrhage Secondary to Blast Injury

Blast injuries to the face frequently involve vascular injury and have been reported in association with vehicles, including compressed air hoses and car battery explosions. While related to high-pressure releases, we present the first case of a car tire inflation resulting in tire explosion causing uncontrollable orbital hemorrhage, ocular damage, and the first case of endovascular intervention resulting in resolution of hemorrhage. A 63-year-old male presented after a tire explosion with evisceration of the right eye and uncontrollable hemorrhage from the orbit. CT demonstrated multiple maxillofacial fractures. Due to persistent hemorrhage, he was taken for emergent endovascular evaluation. On the angiogram, there was noted to be active extravasation from the right meningo-ophthalmic artery. Onyx® embolization of the right meningo-ophthalmic artery was performed with no further hemorrhage. Due to the severity of the injury, ophthalmology was unable to preserve vision in the eye. Arterial hemorrhages are traditionally managed with surgical exploration. However, endovascular management may be of particular utility in vascular injuries to the head and neck region. We highlight the importance of endovascular intervention to treat uncontrollable hemorrhage from orbit.