Posterior ischemic optic neuropathy (PION) secondary to acute orbital hemorrhage: a case report and literature review.

We present a case and literature review regarding posterior ischemic optic neuropathy (PION) in the context of orbital hemorrhage following cosmetic blepharoplasty. A 49-year-old male patient, who underwent resection of residual fat from a previous blepharoplasty, developed acute orbital hemorrhage six hours postoperatively, with sudden visual loss, painful proptosis, and a relative afferent pupillary defect. Urgent decompressive surgery was performed. Ultimately, the patient did not experience visual improvement, and optic atrophy was evident one month later, confirming the diagnosis of PION. Potential pathophysiological mechanisms include direct nerve compression, venous stasis, epinephrine-induced vasoconstriction, vascular steal phenomena, orbital fat traction, and alterations in coagulation and blood pressure. The various hemodynamic, orbital, and systemic mechanisms demonstrate the importance of considering PION as a possible cause of acute visual loss after eyelid procedures.