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Adrianna D Jensen,1 Kamil Taneja,1,2 Meleha T Ahmad,1,3 Fasika A Woreta,1 Fatemeh Rajaii1 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA; 3Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USACorrespondence: Fatemeh Rajaii, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 505, Baltimore, MD, 21287, USA, Tel +1-410-955-1112, Fax +1-410-614-9987, Email frajaii1@jhmi.eduPurpose: To determine the incidence, characteristics, and costs associated with orbital hemorrhages presenting to US EDs.Patients and Methods: This was a retrospective, longitudinal study of the Nationwide Emergency Department Sample, 2006 to 2018. Medical records from patients presenting to participating hospital-owned EDs and diagnosed with primary or secondary orbital hemorrhage were examined to determine incidence, demographics, clinical characteristics, mechanism, disposition and related risk factors, and costs.Results: From 2006 to 2018, an estimated 20,762 US ED visits included an orbital hemorrhage diagnosis. Most primary diagnosis patients were elderly (35%) and male (51%), and incidence increased from 1.1 (95% CI: 0.8– 1.4) to 3.1 per million (95% CI: 2.5– 3.7, p < 0.0001). Fall was the most common mechanism (21.6%), particularly among the elderly (39.9%). Fall-related diagnoses increased from 0.03 (95% CI: − 0.01– 0.07) to 1.0 per million (95% CI: 0.7– 1.3, p < 0.0001), while overall falls increased by only 7%. Assault-related orbital hemorrhage increased from 0.1 (95% CI: 0.0– 0.2) to 0.6 per million (95% CI: 0.4– 0.7, p < 0.0001), while overall assaults decreased by 22%. Annual total ED costs increased from &dollar;463,220 (95% CI: 233,993– 692,446) to &dollar;6,117,320 (95% CI: 4,665,403– 7,569,237, p < 0.001). Inpatient admission was uncommon (9.0