Nontraumatic subperiosteal orbital hemorrhage

Nontraumatic orbital hematoma secondary to labor and childbirth: a case report and review of the literature

PURPOSE

Non-traumatic orbital hemorrhage without underlying vascular malformations or predisposing conditions is uncommon, and particularly rare in the context of maternal labor. This study combines a novel case report and retrospective review to analyze reported cases and propose insights.

METHODS

This study is both a unique case report and literature review examining PubMed publications with articles traced back to original sources through citations for inclusion. Analysis included clinical presentation, visual examination, hematoma characteristics, neuroimaging, management strategies, and outcomes.

RESULTS

We present a 37-year-old multigravida woman at 40 weeks gestation who developed acute right-sided proptosis, diplopia, retrobulbar pain, and periorbital edema during the second stage of labor. Computed tomography (CT) revealed a subperiosteal hemorrhage, with subsequent magnetic resonance imaging (MRI) excluding vascular anomalies. Symptoms resolved within two months. Only 14 cases of maternal orbital hematoma associated with labor have been reported. The average age was 28 with 42% (6/14) being primigravid. Including our case, forty percent (6/15) developed symptoms during the second stage of labor, 40% (6/15) immediately postpartum, and 20% (3/15) over 24 hours postpartum. Overall, 33% (5/15) had potentially contributing conditions including coagulopathies, delivery complications, or vascular malformations. Unilateral orbital hemorrhage occurred in 87% (13/15). Surgical intervention was necessary in 13% (2/15). Most (87%, 13/15) underwent observation or medical management with full recovery of symptoms.

CONCLUSIONS

Non-traumatic orbital hematomas associated with maternal labor are rare and likely related to increased valsalva during delivery and heightened blood volume in pregnancy. Neuro-imaging and systemic workup are recommended to assess for vascular anomalies or underlying coagulopathies. The overall prognosis is favorable with most having full recovery.

An Unusual Case of Bilateral Subperiosteal Orbital Hemorrhage

Subperiosteal orbital hemorrhage usually occurs in the setting of facial or orbital trauma. Non-traumatic subperiosteal orbital hemorrhage (NTSOH) has rarely been reported in literature. The proposed mechanism of NTSOH is the transmission of sudden increase in cranial venous pressure to the orbital veins, which are valveless. We present a case of a 37 year old right-handed woman with a past medical history significant for type 1 diabetes, end-stage renal disease, peripheral artery disease and hypertension who developed NTSOH following an elective revision of a clotted right upper extremity arteriovenous fistula. During this procedure, she had acute eye pain, bilateral complete vision loss and emesis. CT of the orbits revealed large heterogeneously hyperdense lesions in the bilateral orbital apex extending anteriorly along the roof of the orbit, concerning for hemorrhage. Cultures obtained through nasal endoscopy were negative for a bacterial or fungal infection involving the sinuses. Ophthalmology was consulted and she underwent bilateral canthotomy and lateral cantholysis. Postoperatively, she was started on systemic and topical ocular antihypertensives, as well as prophylactic antibiotics. Visual acuity remained poor with finger counting on the right eye and lack of consistent response to light on the left eye. This case highlights periprocedural increase in systemic venous pressure secondary to a fistula repair procedure as a potential cause of NTSOH.

Spontaneous orbital hemorrhage in a case of acute liver failure

Purpose

To report an unusual case of spontaneous orbital hemorrhage in the setting of DIC and hepatic failure.

Observations

A 33-year-old female presented to the Emergency Department (ED) with acute liver failure. During the first week of her hospital admission, she developed unilateral eyelid swelling and proptosis, prompting a consult to ophthalmology. Additional physical examination revealed significantly decreased visual acuity, extraocular muscle restriction, afferent pupillary defect, and increased intraocular pressure. Computed tomography (CT) and ultrasound confirmed the diagnosis of intraorbital hemorrhage. Aggressive management in the form of lateral canthotomy, cantholysis, and septolysis was unable to be performed due to the patient's multiple comorbidities outweighing the potential benefits.

Conclusions and importance

This rare phenomenon is unique from previous existing literature in that the timing of the incident limited the therapeutic options for this patient, additional imaging in the form of ultrasound was utilized in the work-up, and to our knowledge this is the second case of spontaneous orbital hemorrhage as a complication of disseminated intravascular coagulation (DIC) caused by hepatic failure.

Orbital subperiosteal hematoma associated with frontal and ethmoidal sinusitis

BACKGROUND

We report a rare case of orbital subperiosteal hematoma associated with frontal and ethmoidal sinusitis. Common concerns involving the orbital subperiosteal space include abscess, hematoma and tumor.

CASE PRESENTATION

A patient presented to our clinic with periorbital swelling and limited extraocular muscle movement in her left eye. Computed tomography revealed a superior subperiosteal mass with frontal and ethmoidal sinusitis. We diagnosed the patient with subperiosteal hematoma and surgical evacuation was performed via superior orbitotomy. Brown serous discharge was drained and biopsy demonstrated fibrin clots. The final diagnosis was orbital subperiosteal hematoma and the patient was discharged with symptoms resolved.

CONCLUSION

Orbital subperiosteal hematoma is difficult to distinguish from abscess owing to its rarity and similar presentation. Computed tomography is helpful in diagnosis, and surgical evacuation during the early stages is essential to achieving a good outcome.

Bulbar conjunctival vascular lesion combined with spontaneous retrobulbar hematoma: A case report

BACKGROUND

Orbital hemorrhage can be classified as traumatic or spontaneous depending on its cause. Spontaneous orbital hemorrhage refers to an internal orbital hemorrhage without apparent cause. Therefore, we aimed to describe a case of an orbital hematoma after a severe cough the night before due to inhalation of cooking oil fumes.

CASE SUMMARY

A 46-year-old woman was referred to our hospital with a complaint of exophthalmos accompanied with blurred vision, pain, binocular diplopia, and dizziness lasting for 5 h noted on waking in the morning. She also experienced nausea and vomiting due to high pressure of orbit and dizziness. Based on the auxiliary examination and her medical history, the patient was finally diagnosed with bulbar conjunctival vascular lesion combined with spontaneous retrobulbar hematoma. The patient was administered tobramycin and dexamethasone eye ointment, and applied pressure dressing on the left eye to stop the bleeding. Simultaneously, we administered intravenous etamsylate, oral Yunnan Baiyao capsule, intravenous mannitol to reduce orbital pressure, and intravenous dexamethasone injection at 10 mg/dL combined with neurotrophic therapy to reduce tissue edema. Among them, the Yunnan Baiyao capsule is a traditional Chinese herbal medicine to remove stasis and stop bleeding; thus, it promotes blood circulation and relieves pain resulting in reduced edema of the lesion site. The symptoms did not improve significantly during the first 2 d of treatment. We speculate that high orbital pressure and binocular diplopia induced frequent nausea and vomiting in the patient, causing increased pressure on the superior vena cava and leading to repeated orbital bleeding. After the second day, the symptoms started gradually improving.

CONCLUSION

This case further emphasizes the importance of comprehensive, detailed medical history and careful ophthalmic examination of the patient.

Unilateral eosinophilic cellulitis leading to implant extrusion after bilateral enucleation in a dog

A mixed breed dog underwent bilateral enucleation with orbital implant placement for secondary glaucoma. Subsequent unilateral implant extrusion occurred. An orbital mass histologically consistent with eosinophilic cellulitis was discovered. It may have developed secondary to communication between orbit and skin. Inflammatory processes mimicking neoplasia can cause implant loss post‐enucleation.

Subperiosteal Orbital Hematoma From SVC Occlusion During Cardiac Surgery: To See or Not to See

We present a case in which the superior vena cava (SVC) cannula was inadvertently clamped for a short while during cardiopulmonary bypass, completely occluding SVC drainage. This resulted in a rarely seen complication - bilateral subperiosteal orbital hematomas causing orbital compartment syndrome. Other instances of intentional SVC occlusion include during the creation of a bidirectional cavo-pulmonary shunt and for emergency control of bleeding during thoracic surgery.

A Narrative Review of the Complex Relationship between Pregnancy and Eye Changes

Pregnancy is a condition often characterized by changes that occur in different parts of the body. Generally, the eyes suffer several changes during pregnancy that are usually transient but may become permanent at times. This may occur due to the release of placental hormones and those of maternal endocrine glands and fetal adrenal glands. Due to hormonal influences, physiological ocular changes during pregnancy have been shown in Caucasian women, so corneal sensitivity, refractive status, intraocular pressure, and visual acuity may change during pregnancy. Within this review, all studies that referred to physiological aspects and to changes of ocular pathology of pregnancy, the effect of the pregnancy on pre-existing (diabetic retinopathy, neuro-ophthalmic disorders) eye disorders, postpartum ocular changes, the intraocular pressure and the effect of hypotensive ophthalmic medicine during pregnancy, the connection between pregnancy and the neuro-ophthalmic pathology, as well as the role of anesthesia were analyzed.

Spontaneous subperiosteal orbital hematoma in a patient with chronic sinusitis

Periorbital swelling is a common presentation to the emergency department (ED), and its etiology can range from benign to acutely vision-threatening. Orbital subperiosteal hematoma is a rare ED diagnosis that is typically associated with trauma, though can infrequently occur spontaneously in the setting of sudden elevations in cranial venous pressure, bleeding diathesis, and sinusitis. We present a case of a 55-year-old female with a history of chronic sinusitis who presented to the ED with a three-day history of left-sided periorbital swelling along with painful extraocular movements and markedly decreased visual acuity following a cross-country road trip through elevation. Contrast computed tomography scan of the orbits revealed a large extraconal collection in the subperiosteal space causing significant mass effect on the left globe, along with findings of diffuse sinonasal disease bilaterally. Intravenous antibiotics were started immediately and the patient underwent surgical incision and drainage of the subperiosteal space, where she was diagnosed with a spontaneous subperiosteal orbital hematoma secondary to chronic sinusitis. Within the literature, there are fewer than 20 case reports of orbital subperiosteal hematoma secondary to sinusitis. The purpose of this case report is to assist emergency physicians in considering the rare but potentially vision-threatening condition of spontaneous subperiosteal orbital hematoma within their differential diagnosis of patients with periorbital swelling and proptosis, as well as to provide an approach to management within the ED.

Subperiosteal Orbital Hemorrhage: An Unusual Complication During Labor

ABSTRACT

Subperiosteal orbital hemorrhage in the postpartum period has been rarely reported. The authors herein present a female patient who developed acute-onset vertical diplopia, proptosis, mild retro-orbital pain, and restriction of upgaze immediately after labor. Neuroimaging revealed a subperiosteal hematoma along the right orbital roof. Diplopia, motility limitation, and retro-orbital pain gradually resolved in the following weeks. Subperiosteal orbital hematomas are a rare complication of labor, with only 12 cases reported so far. They result from straining during labor, which increases central and orbital venous pressure by means of the Valsalva-maneuver. In order to evaluate ocular motility and exclude optic nerve compression, an urgent ophthalmological examination is required.

Acute subperiosteal orbital haematoma following general anaesthesia in the setting of recent trauma

Subperiosteal orbital haematoma (SOH) is an uncommon condition that involves bleeding within the potential space between the periosteum and orbital bone. This typically occurs within the superior orbit. If the SOH is large enough it can compress orbital structures and be sight threatening. Therefore, it is important for the clinician to recognize the potential causes for this phenomenon which will help guide the diagnosis. Herein we describe a unique case of unilateral SOH in a 47-year-old male following otherwise uncomplicated general anaesthesia. This occurred 6 weeks after a motorbike accident in which there was no facial/ocular injury. This case report identifies for the first time the potential for a late-onset SOH in the setting of a stressor event. It also highlights the potential for this condition to occur following general anaesthesia in a supine patient having a non-cardiac procedure, previously recognized as a potential stressor.

Subperiosteal Orbital Hematoma: An Uncommon Complication of Acute Sinusitis

Non-traumatic subperiosteal orbital hematoma is a rare finding and uncommon cause of proptosis. Reported cases describe an association with increased venous pressure. However, it is important to note that there is also an association with sinusitis, which must be differentiated from subperiosteal abscess. This article describes the unique imaging features of subperiosteal hematoma in the setting of sinusitis, as well as the suspected pathophysiology.

Nontraumatic subperiosteal orbital hemorrhage in a laboring patient with gestational immune thrombocytopenic purpura

Purpose

To describe a case of nontraumatic subperiosteal orbital hemorrhage (NTSOH) in a laboring patient with gestational immune thrombocytopenic purpura.

Observations

A 28-year-old G3P2 laboring patient was urgently evaluated by our ophthalmology unit after she developed sudden onset left eye proptosis, headache, and diplopia in the final hour of pushing. The patient's platelet count was markedly decreased at 45,000 and subsequent work-up established a diagnosis of gestational immune thrombocytopenic purpura. On examination, visual acuity was 20/25 bilaterally and there was a minus two restriction in upgaze in the left eye and a left hypotropia in primary position. Computed tomography demonstrated an elliptical, hyperdense collection at the left orbital roof consistent with NTSOH. The patient was deemed clinically stable through serial examinations and symptoms resolved with conservative management.

Conclusions and Importance

NTSOH is a rare, potentially sight-threatening condition that requires timely ophthalmological evaluation. To our knowledge, this is the first report in the literature of NTSOH in a laboring patient with gestational immune thrombocytopenic purpura. Consideration of the possibility of NTSOH as a complication in this population may allow for appropriate diagnosis, monitoring, and treatment when indicated.

Spontaneous unilateral exophthalmos after a vaginal delivery

INTRODUCTION

Spontaneous orbital exophthalmos is an extremely rare incident during a vaginal delivery. In most cases, it is associated with venous malformations and presents spontaneous resolution.

CASE DESCRIPTION

We report a case of orbital hematoma after vaginal delivery due to a superior ophthalmic vein rupture. The patient presented proptosis of the right eye and diplopia immediately after the delivery and was diagnosed with unilateral orbital hematoma. The patient was given conservative treatment with complete resolution of clinical symptoms 4 weeks after the delivery.

CONCLUSION

Increased abdominal pressure during a vaginal delivery may lead to a spontaneous orbital hemorrhage.

Nontraumatic Subperiosteal Orbital Hematoma in a Patient With Behcet Disease

Orbital subperiosteal hematomas are commonly caused by facial trauma. Nontraumatic subperiosteal orbital hematomas (NTSOHs) are rare but may occur in patients with underlying medical diseases. A 71-year-old woman presented to the emergency department with a 5-day history of left periorbital pain and proptosis. She was known to have Behcet disease and presented with no recent trauma. Clinical features and computed tomography findings aided in establishing the diagnosis of an NTSOH. The hematoma was evacuated via sub brow incision. After surgery, the patient's clinical symptoms resolved and did not recur during the 12-month follow-up period. On the basis of the findings of this case, the authors conclude that patients diagnosed with diseases such as bleeding disorders or autoimmune vasculitis should consider visual symptoms as a sign of an NTSOH. Patients who diagnosed with disease experience visual disturbance, periorbital pain, or periorbital swelling should undergo early surgical treatment for spontaneous NTSOH to avoid permanent visual loss.

Subperiosteal Hematoma of the Orbit: A Variety of Presentations

Subperiosteal hematoma of the orbit is an uncommon radiologic finding. Most typically, the hemorrhage is in the superior aspect of the orbit, however, location within the orbit may vary. Subperiosteal hematoma of the orbit may be associated with trauma. Nontraumatic etiology has also been well documented. We present a series of three cases, to illustrate typical and atypical radiologic findings of subperiosteal hematoma of the orbit, both traumatic and nontraumatic. Review of the pertinent radiologic literature and its relation to the cases presented here is also provided.

Erotic asphyxiation: May have you seeing double

Purpose

If not recognized and treated promptly, nontraumatic orbital subperiosteal hemorrhage (NTSOH) can have serious sequelae including compressive optic neuropathy and permanent vision loss. The following case establishes erotic asphyxiation as a cause of NTSOH.

Observations

A 29 year-old patient presented with diplopia and periorbital edema and ecchymosis. Complete ophthalmologic exam showed no optic neuropathy. Computed tomography of the orbits revealed a subperiosteal fluid collection in the right orbit. The patient had no risk factors for NTSOH, but after detailed questioning she admitted to participating in erotic asphyxiation prior to the onset of her symptoms. She was observed and subsequently lost to follow up.

Conclusions and Importance

To the authors' knowledge, erotic asphyxiation as a cause of orbital subperiosteal hematoma has not been previously reported. Lack of knowledge about erotic asphyxiation amongst healthcare providers may contribute to hesitance to directly question patients about the practice. Clinicians should be aware of erotic asphyxiation as a potential cause of orbital subperiosteal hemorrhage.

Subperiosteal haematoma of the orbit secondary to frontal sinusitis

Reported is the case of a 79-year-old woman initially diagnosed with periorbital abscess on the background of a recent upper respiratory tract infection. Unexpectedly, intraoperative findings were that of a haematoma rather than an abscess. Subperiosteal orbital haematoma (SOH) is an extremely rare complication of rhinosinusitis. In contrast to the more common periorbital abscess, it is seldom listed as a complication of sinusitis. A review of reported cases suggests an older patient demographic are affected by SOH in contrast to periorbital abscess which typically affects paediatric patients. Given current demographic trends toward an older patient population with multiple comorbidities, failure to consider SOH as a differential will have important implications on preoperative workup, perioperative care and final outcome for patients. We present this case as a reminder of a rare but important complication of a common disease.

Nontraumatic subperiosteal orbital hemorrhage following upper gastrointestinal endoscopy

Subperiosteal hemorrhages are typically the result of blunt orbital or facial trauma. Nontraumatic subperiosteal hemorrhages are uncommon and are usually attributed to increase in central venous pressure and bleeding disorders. Here, we report the case of a 38-year-old female who underwent an upper gastrointestinal (GI) endoscopy and developed bilateral nontraumatic subperiosteal hemorrhages that resolved with conservative treatment. Here, we discuss the source of bleeding and the mechanisms for the occurrence of orbital subperiosteal bleeds. GI surgeons and ophthalmologists should be sensitive to the possibility that orbital hemorrhage that can occur following endoscopy, especially when retching or gagging occurs during the procedure.

The 2017 Doyne Lecture: the orbit as a window to systemic disease

A very large number of disorders affect the orbit, and many of these occur in the setting of systemic disease. This lecture covers selected aspects of orbital diseases with systemic associations in which the author has a particular clinical or research interest. Spontaneous orbital haemorrhage often occurs in the presence of bleeding diatheses. Thrombosis of orbital veins and ischaemic necrosis of orbital and ocular adnexal tissues occur with thrombophilic disorders, vasculitis, and certain bacterial and fungal infections. Non-infectious orbital inflammation commonly occurs with specific inflammatory diseases, including Graves' disease, IgG4-related disease, sarcoidosis, Sjögren's syndrome and granulomatosis with polyangiitis, all of which have systemic manifestations. IgG4-related ophthalmic disease is commoner than all these except Graves' orbitopathy. Some of these orbital inflammatory diseases are associated with an increased risk of B-cell lymphoma, usually marginal zone lymphoma of MALT type. Ocular adnexal lymphoma also has an association with infectious agents including Helicobacter pylori and Chlamydia psittaci. Orbital metastasis may be the first presentation of systemic malignancy. A number of orbital neoplasms occur in the setting of familial cancer syndromes, including Neurofibromatosis types 1 and 2. Study of the genetics and molecular biology of orbital diseases such as Graves' orbitopathy and idiopathic orbital inflammatory disease will yield useful information on their diagnosis and management.

Bilateral orbital compartment syndrome in a patient with disseminated intravascular coagulation

A 39-year-old male developed bilateral periorbital oedema and tense orbits in keeping with orbital compartment syndrome (OCS) shortly after presenting to the emergency department for uncontrollable epistaxis. Bilateral lateral canthotomy and inferior cantholysis was performed within 30 minutes of onset, with the left side further decompressed via superior cantholysis. Computed tomography demonstrated bilateral proptosis and optic nerve stretch, but no intraorbital haemorrhage or haematoma. Laboratory findings were consistent with disseminated intravascular coagulation (DIC) and sepsis of unknown origin. The right visual acuity recovered to 6/6 -2 from counting fingers, but the left eye failed to improve beyond light perception. This unique case of OCS is the first associated with DIC which had no evidence of intraorbital haemorrhage.

Spontaneous Unilateral Subperiosteal Hematoma in the Orbit due to Self-Induced Asphyxia: Unusual Cause of Unilateral Exophthalmos

BACKGROUND

To report an unusual case of subperiosteal bleeding of nontraumatic etiology.

CASE DESCRIPTION

A 48-year-old female presented with an acute protrusion of the left eye after nonaccomplished suicide by means of asphyxia using a cable around the neck. At the time of presentation, the MRI showed an orbital subperiosteal hematoma causing an exophthalmos. After conservative treatment, there was a complete remission of the lesion.

CONCLUSION

Nontraumatic subperiosteal bleedings without involvement of the intraocular structures and no vision-threatening intraorbital changes should be treated conservatively.

Retrobulbar Hematoma After Heart Transplantation: Case Report and Literature Review

Spontaneous retrobulbar hemorrhage is a rare phenomenon observed after surgery not directly involving the orbit. When it occurs, presentation is usually obvious, and it carries high morbidity unless emergent and timely surgical treatment is instituted. There are only a handful of cases associated with cardiac surgery, and to our knowledge no cases with heart transplantation. We present a case of a 35-year-old woman who underwent orthotopic heart transplantation for peripartum cardiomyopathy and developed spontaneous retrobulbar hemorrhage.

Intraorbital haematoma during a commercial flight: a case report

Background

Intraorbital haematoma is a rare clinical entity which can be caused by orbital traumas, neoplasms, surgeries nearby sinuses and orbit, vascular malformations, acute sinusitis, systemic abnormalities, barotrauma and valsalva maneuver.

Case Presentation

A 74-year-old male presented with sudden onset of ocular pain, upper eye lid swelling, proptosis and diplopia after a commercial flight. After complete ophthalmic ocular examination including pupillary light reflexes and laboratory examinations; computed tomography and magnetic resonance imaging of orbit revealed a subperiostal mass-like lesion in the right retrobulbar-extraconal region which was compatible with intraorbital haematoma. Visual acuity was not compromised so we planned a conservative approach with close observation. We administered systemic corticosteroid and topical dorzolamide/timolol combination therapy. At the first month follow-up, intraorbital haematoma resolved without significant sequelae.

Conclusion

Intraorbital haematoma can be managed by conservative approach without any intervention if it does not threat visual acuity or optic nerve. We experienced a case of intraorbital haematoma during a commercial flight. We discussed the rarity of this condition and its management.

Cirrhosis-related coagulopathy resulting in disseminated intravascular coagulation and spontaneous orbital hemorrhages

A 33-year-old patient presented to our Emergency Department (ED) with left-sided eyelid ecchymoses and edema. A CT scan of the orbits demonstrated a left retrobulbar hemorrhage, prompting an ophthalmology consultation. Upon examination, the patient reported worsening eye pain and decreasing vision in the left eye. Despite aggressive management with superior and inferior lateral canthotomy/cantholysis with placement of an orbital drain, visual loss occurred, and the patient ultimately expired from her systemic condition. Coagulopathy from liver disease resulting in systemic hemorrhage is commonly seen. Orbital hemorrhage in this setting requires emergent diagnosis and management to prevent irreversible compressive optic neuropathy.

Nontraumatic subperiosteal bilateral orbital hemorrhages after mitral valve repair

Nontraumatic subperiosteal orbital hemorrhages (NTSOHs) are rare events, but pose a grave risk of vision loss and must be evaluated carefully for optic nerve compromise. To the author's knowledge, only 2 cases of NTSOH after cardiovascular procedures have been reported. The authors report a unique case of bilateral NTSOH with optic neuropathy that developed after cardiothoracic surgery and reaccumulated after orbitotomy. The case presentation conforms to the tenets of the Declaration of Helsinki and is Health Insurance Portability and Accountability Act compliant. The etiology and management of this uncommon and dangerous entity will be discussed.

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.

Spontaneous subperiosteal orbital hemorrhage

Subperiosteal orbital hemorrhage typically results from trauma. Spontaneous subperiosteal orbital hemorrhage (SSOH) is rare and has been reported with sudden elevation of cranial venous pressure, bleeding diathesis, and sinusitis. This article presents a series of 9 patients (11 orbits) with SSOH and review the associated systemic conditions. 10 out of 11 orbits (91%) underwent surgical intervention due to advanced orbital signs or poor vision.

Spontaneous subperiosteal hematoma precipitated by anxiety attack

A 60-year-old woman presented with diplopia and left periorbital edema and pressure, which developed during an anxiety attack the previous day. Examination revealed left inferotemporal globe dystopia, periorbital edema, ecchymosis, and limitation in supraduction. Orbital MRI confirmed the diagnosis of a superior subperiosteal orbital hematoma. The patient's signs and symptoms rapidly resolved with administration of oral corticosteroids. The patient remains asymptomatic with complete resolution of orbital signs at 3-month follow-up. Subperiosteal orbital hematoma (SOH) is a rare condition in which blood accumulates between the bony orbit and separated periosteum, and is often due to blunt head trauma. Non-traumatic SOH (NTSOH) is exceedingly rare and usually associated with known coagulopathies or tendency to bleed. However, few cases of spontaneous NTSOH have been reported without any such predisposition and are thought to be caused by sudden elevations in intrathoracic and intracranial venous pressure such as vomiting, coughing, SCUBA diving, weight lifting and labor. We herein describe the presentation, radiography and outcome of a unique case of spontaneous NTSOH following an anxiety attack.

Orbital hemorrhage as a primary manifestation of disseminated intravascular coagulation (DIC) associated with intrauterine fetal death and placental abruption

Introduction: Disseminated intravascular coagulation (DIC) is a serious complication of obstetric emergencies, and its clinical manifestation occurs in various organs and tissues. Ocular and orbital involvement has been reported only rarely.

Presentation of the case: A 15-year-old primigravida complained about loss of vision in the right eye for 3 days. Magnetic resonance imaging showed a retrobulbar hemorrhage. A first diagnosis of pregnancy (estimated gestational age of 23 weeks) was made, and intrauterine fetal death was diagnosed by ultrasound examination. Laboratory workup revealed the diagnosis of DIC. Due to massive vaginal bleeding a cesarean section was performed, and placental abruption was diagnosed intraoperatively.

Discussion: The concomitance of intrauterine fetal death and other obstetric complications such as placental abruption might induce a fulminant coagulopathy with severe consequences even with uncommon organ localization.

Case of bilateral non-traumatic subperiosteal orbital haematomas

Subperiosteal orbital haematoma is an uncommon entity, usually unilateral and caused by trauma. We present a unique case of bilateral non-traumatic subperiosteal orbital haematomas caused by thrombolysis and anticoagulation.

Acute presentation of vascular disease within the orbit-a descriptive synopsis of mechanisms

Vascular events in the orbit can present with an acute onset of symptoms, and, if untreated, raised orbital pressure and reduced arterial perfusion can lead to loss of orbital functions. Such events are commonly due to haemorrhage, but can also be due to arterio-venous shunts and very rarely arise from intraorbital vascular occlusion. The likely diagnosis is often evident on taking a thorough history and examination and in most cases, after appropriate imaging, the process can be monitored for progression. Visual failure is usually due to high pressure at the orbital apex, resulting in ischaemic optic neuropathy, and any evidence of a persistent significant visual impairment should prompt intervention.