Spontaneous retrobulbar hematoma (SRH) after heart transplantation is an exceptional condition that puts vision at risk. Bleeding in the retrobulbar space provokes an anterior ocular displacement, extending the vessels and the optic nerve, which can generate ischemic neuropathy and finally a loss of vision (1). A Retrobulbar hematoma is usually associated with trauma or eye surgery. Though, in non9 traumatic cases, the underlying cause is not evident. In complex surgeries like heart transplantation, an adequate ophthalmologic examination is usually not performed. However, this simple measure can prevent permanent vision loss. Non-traumatic risk factors should also be considered, which include vascular malformations, bleeding disorders, use of anticoagulants, and increased central venous pressure (CVP) usually triggered by a Valsalva maneuver (2). The clinical presentation of SRH consists of ocular pain, decreased visual acuity, conjunctival chemosis, proptosis, abnormal extraocular movements, and elevated intraocular pressure (IOP). Its diagnosis is often clinical; however, it can be confirmed with computed tomography (CT) or magnetic resonance imaging (MRI). Treatment aims to reduce intraocular pressure either with surgical decompression or pharmacological measures (2). In the reviewed literature, less than 5 spontaneous ocular hemorrhages (SOH) related to cardiac surgery have been reported (3–6), of which only one is related to heart transplantation (3). A clinical challenge of an SRH after heart transplantation is presented below. Surgical management was performed with a favorable result.