Bilateral subperiosteal orbital hematomas in a child with sickle cell disease

Isolated Unilateral Orbital Compression Syndrome in A 19-Year-Old Male With Homozygous Sickle Cell Disease

This study aimed to report a rare case of a rapidly progressive isolated unilateral orbital compression syndrome in a male with homozygous sickle cell disease, who presented with proptosis and optic nerve dysfunction. He neither had long bone pain crisis nor fever at the time of presentation that was managed surgically to preserve vision. Rapidly progressive left orbital swelling is observed in a 19-year-old homozygous sickle cell disease patient associated with severe pain, headache, and impaired vision. Computed tomography of the orbit confirmed the presence of a unilateral large superior sub-periosteal cystic mass. Surgical exploration via anterior orbitotomy revealed a large sub-periosteal hematoma occupying the superior orbit which was evacuated. The patient completely recovered within 14 days post-surgery and regained his vision. Orbital involvement in sickle cell disease is rare, however, it can occur as a sequela of vaso-occlusive crisis and bone marrow infarctions leading to bleeding and sub-periosteal hematomas in the orbit. Prompt diagnosis and management of orbital compression syndrome are crucial to prevent permanent optic nerve damage. Hence, cautious evaluation and close monitoring are important, especially in cases where surgical evacuation is indicated for quick recovery and prevention of visual loss.

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 hematoma of the orbit

Orbital subperiosteal hemorrhage is rare, with most cases occurring in young males as a result of direct facial or orbital trauma. The authors present a case of a spontaneous subperiosteal hematoma of the orbit in a 4-year-old girl.

Orbital infarction in sickle cell disease

PURPOSE

To determine the role of hematological and genetic factors in the development of orbital infarction in sickle cell disease.

DESIGN

Retrospective, noncomparative case series.

METHODS

Fourteen sickle cell disease patients were diagnosed with orbital infarction during a vaso-occlusive crisis. Clinical and radiological findings were reviewed retrospectively. Sickle cell disease patients without orbital infarction were recruited as controls after matching for disease severity. Sickle haplotypes were determined for all patients. Differences between groups were evaluated statistically.

RESULTS

Patients with orbital infarction in sickle cell disease presented with acute periorbital pain and swelling with or without proptosis, ophthalmoplegia, and visual impairment during a vaso-occlusive crisis. Radiological findings included orbital soft tissue swelling (100%), hematoma (orbital, 36%; intracranial, 21%), and abnormal bone marrow intensities. Severity of orbital involvement was unrelated to that of the systemic disease (Pearson correlation coefficient, -0.1567). Affected patients predominantly had the Benin haplotype (P < .00782).

CONCLUSIONS

Orbital infarction is a potential threat to vision in sickle cell disease patients. Magnetic resonance imaging is more specific than computed tomography or nuclear scintigraphy in the evaluation of orbital changes. The degree of severity of the orbital manifestations appears unrelated to the severity of sickle cell disease. Patients with the Benin haplotype are more likely to develop orbital infarction during vaso-occlusive crises.