Spontaneous subperiosteal hematoma of the orbit

Spontaneous bleeding from orbital haemangioma in drug-induced thrombocytopaenia

An 81-year-old woman, a drug-induced thrombocytopaenia (DITP) patient, presented with a case of spontaneous bleeding from an orbital haemangioma manifesting as a sudden onset of ocular pain, proptosis and limited eye movement. Image studies revealed an extraconal, cystic lesion with haemorrhage. The ophthalmopathy was caused by the bleeding of the orbital haemangioma and it was resolved after embolisation of the feeding vessels. Spontaneous bleeding of orbital haemangioma is rare. This case emphasises that DITP may be the cause of spontaneous bleeding of orbital haemangioma by precipitating the inflammatory reactions within the tumour, which further cause the haemodynamic disturbances and ultimate spontaneous bleeding.

Nontraumatic orbital hemorrhage

Nontraumatic orbital hemorrhage (NTOH) is uncommon. I summarize the published reports of NTOH and offer a classification based on anatomic and etiologic factors. Anatomic patterns of NTOH include diffuse intraorbital hemorrhage, "encysted" hemorrhage (hematic cyst), subperiosteal hemorrhage, hemorrhage in relation to extraocular muscles, and hemorrhage in relation to orbital floor implants. Etiologic factors include vascular malformations and lesions, increased venous pressure, bleeding disorders, infection and inflammation, and neoplastic and nonneoplastic orbital lesions. The majority of NTOH patients can be managed conservatively, but some will have visual compromise and may require operative intervention. Some will suffer permanent visual loss, but a large majority have a good visual outcome.

Subperiosteal hematoma in multiple settings

Most reports of orbital hemorrhage do not distinguish among intraconal, extraconal, and subperiosteal hemorrhages, although several reports describe isolated subperiosteal hematomas as a separate entity. We report 3 cases of subperiosteal hematoma with different etiologies but similar progression of signs and symptoms. Each patient presented with spontaneous proptosis, rarely caused by orbital subperiosteal hematoma, measuring approximately 5 mm. Over the course of 4-10 days their conditions worsened and warranted intervention. All 3 cases were treated with anterior orbitotomy, and visual acuity returned to baseline following surgery in all.

Subacute phase treatment of subperiosteal hematoma of the orbit with epidural hematoma in the frontal cranial fossa: case report

Background

Subperiosteal hematoma of the orbit is one of the rare lesions that cause exophthalmos after craniomaxillofacial trauma. Presently, there is no consensus for how to treat this disease. Although some reports have suggested a conservative type of therapy, others have recommended surgical treatments be done during the early stages.

Case presentation

This case report provides details on the clinical course of a 9-year-old girl with subperiosteal hematoma of the orbit. In this particular patient, a rare case of ipsilateral subfrontal extradural hematoma was also observed. Due to our performing the surgical intervention during the subacute stage, functional complications as well as cosmetic problems were avoided.

Conclusion

Our results demonstrate that surgical treatments for subperiosteal hematoma of the orbit should be delayed until it can be confirmed that a patient has no other complications. On the other hand, once it has been confirmed that the patient has no other existing problems, immediate surgical therapy with a small skin incision followed by the setting of a drain is recommended in order to achieve an early resolution and avoid complications.

Idiopathic orbital hemorrhage related to the inferior rectus muscle: a rare cause for acute-onset diplopia and unilateral proptosis

PURPOSE

To report 6 patients with spontaneous orbital hemorrhage in relation to the inferior rectus muscle.

DESIGN

Retrospective observational case series.

PARTICIPANTS

Six patients with acute onset orbital pain, diplopia, and proptosis referred to the orbital clinic at the Royal Victorian Eye and Ear Hospital, January 1995 through December 2004.

METHODS

Review of clinical history, imaging studies, and follow-up.

MAIN OUTCOME MEASURES

Resolution of proptosis and diplopia and imaging studies of the orbit, including computed tomography (CT), magnetic resonance imaging (MRI), or both.

RESULTS

Six patients (4 men, 2 women; mean age, 68 years) were referred with acute onset of unilateral proptosis and diplopia. None of the patients had a history of bleeding disorder. Visual acuity and intraocular pressure were normal; 3 patients showed marked limitation in upgaze on the affected side. Imaging studies of the orbit by CT, MRI, or both showed inferior orbital hemorrhage either within (4 patients) or adjacent to (2 patients) the inferior rectus muscle, possibly within the muscular sheath. Symptoms resolved completely in all but 1 patient, who had persistent diplopia in extreme upgaze. Follow-up CT, MRI, or both showed complete resolution in 3 patients and mild persistent inferior rectus muscle thickening in 2 patients.

CONCLUSIONS

Acute onset proptosis and diplopia may be secondary to spontaneous orbital hemorrhage within the inferior rectus muscle or its sheath with no other orbital or systemic pathologic features. Symptoms resolved spontaneously over the course of days to weeks, and orbital imaging showed complete resolution or mild persistent enlargement of the muscle without significant symptoms.

Interferon alpha-2a for proliferative diabetic retinopathy after complete laser panretinal photocoagulation treatment

BACKGROUND AND OBJECTIVE

The aim of this study was to investigate the effect of interferon alpha-2a, an angiogenesis inhibitor, on eyes with active neovascularization after complete laser panretinal photocoagulation treatment.

PATIENTS AND METHODS

Eight patients with active neovascularization persisting for 6 months or more after completion of full panretinal photocoagulation were included in the study. All patients were treated with subcutaneous injections of 6 million international units of interferon alpha-2a, 3 times a week, for an average period of 10 months. Visual acuity, contrast sensitivity, blood tests, fundus photographs, fluorescein angiography, and physical examination were performed periodically. The main outcome measures were visual acuity and extent of neovascularization as assessed by fundus photography and fluorescein angiography.

RESULTS

The 5 men and 3 women (mean age, 60 years) had a mean duration of diabetes of 19 years. The average study follow-up was 42.2 +/- 8.7 weeks. Visual acuity and extent of neovascularization improved or remained stable in 7 patients. In none of the patients was there progression of neovascularization, but in 1 patient it could not be assessed due to vitreous hemorrhage. Most patients had malaise during the first weeks of treatment, but none of the patients suffered from nonreversible side effects associated with interferon alpha-2a.

CONCLUSION

This pilot study provides evidence that interferon alpha-2a might have a role in the regression of proliferative diabetic retinopathy and that further investigation is warranted.

Nontraumatic subperiosteal orbital hemorrhage

PURPOSE

Nontraumatic subperiosteal orbital hemorrhage (NTSOH) has been reported rarely in association with sudden elevation of cranial venous pressure, generalized diseases with bleeding diatheses, and paranasal sinusitis. To define more clearly the clinical and imaging characteristics of NTSOH, we evaluated nine cases seen by the authors and reviewed previous case reports.

DESIGN

Retrospective, noncomparative case series.

PARTICIPANTS

Nine patients (10 eyes) with NTSOH.

INTERVENTION

All patients underwent computed tomography scans of the orbits. Patients with typical clinical and imaging features and normal visual function were observed. Those with an uncertain diagnosis or visual compromise underwent surgical drainage of the hematoma.

MAIN OUTCOME MEASURES

Resolution of proptosis, diplopia, lid swelling, and ptosis.

RESULTS

Nine patients ranging from birth to 73 years of age were identified. All were females. The lesions were located superiorly in eight patients (one patient had bilateral lesions) and medially in one patient. Most were associated with sudden elevation in venous pressure (vomiting, strangulation, straining), and most required no surgical intervention. The bilateral case occurred in the setting of disseminated intravascular coagulation and was the only case associated with visual loss possibly resulting from ischemic optic neuropathy.

CONCLUSIONS

Nontraumatic subperiosteal orbital hemorrhage may occur at any age, usually secondary to sudden elevation in venous pressure. It is nearly always superior. The clinical and radiologic features are sufficiently characteristic to allow conservative treatment in the absence of visual compromise.

Subperiosteal hematoma of the orbit associated with subfrontal extradural hematoma: case report

A patient admitted to hospital with a painful proptosis, diminished visual acuity, and mental status changes was proven to have a large left subfrontal epidural hematoma and an associated subperiosteal orbital hematoma. Surgical intervention resulted in complete recovery of neurologic function and visual acuity. This case demonstrates the unique and previously unreported concurrent diagnosis of epidural and subperiosteal orbital hematoma. The literature is reviewed and surgical management is discussed.

Post-traumatic subgaleal hematoma with subperiosteal orbital extension

Delayed, progressive proptosis is rare following mild head trauma. We describe a case of subperiosteal orbital extension of a subgaleal hematoma and review ten cases from the literature of solitary subperiosteal hematoma and one of subgaleal hematoma with orbital extension. A patient profile, mode of clinical presentation, management options, and an algorithm for management are presented.