ORBITAL HEMORRHAGE FOLLOWING TRIVIAL TRAUMA

Authors :1.Dr. Harshavardhan Reddy2.Dr. Shubhangi Nigwekar3.Dr. Somen Misra

INTRODUCTION

Orbital hematoma can develop following blunt trauma. Only a few cases have been reported in literature. Cases reported were seen in young individuals

Causes of orbital hematoma include:1. Trauma - Most orbital hematomas are

post traumatic due to mechanical disruption of small subperiosteal blood vessels. Left untreated these hematomas may also undergo suppuration leading to abscess formation.

2. Congestion – Orbital hematoma due to congestion is due to transmission of increased pressure from adjacent venous network directly to orbit venous plexus which is devoid of valves.

3. Spontaneous – True spontaneous orbital hematoma is very rare. It should be remembered that even trivial trauma to orbit can cause subperiosteal hematoma of orbit. Straining has been associated with increase in the pressure of orbital veins causing bleeding into orbit.

4. Conditions associated with systemic diseases like leukemia, sickle cell, scurvy and hemophilia can cause orbital hematoma.

CASE REPORT

7 year old female child came to the ophthalmology OPD with complaints of oedema, redness and dimunision of vision in the right eye since 4 days.

Patient gave history of fall from bed 4 days back following which she developed these symptoms along with an abrasion on her forehead.

• General examination of the patient was within normal limits.

• Visual acuity was 6/24 and 6/6 in the right and left eyes respectively.

• On local examination, patient had lid oedema, chemosis and proptosis of the right eye.

• The affected eye along with proptosis, appeared to be displaced in the down and out position.

Signs of exposure keratitis were noted Pupils were reacting to light. Ocular movements were restricted. Routine blood investigations were within normal

range including PT, INR and APTT. B-scan was done which was suggestive of orbital

hemorrhage. CT scan

B-SCAN &CT

ON ADMISSION

AT THE TIME OF DISCHARGE

Patient was started on I.V antibiotics and serratiopeptidase.

She showed signs of improvement and by 10 days lid oedema and chemosis reduced considerably.

Ocular movements were found to be full, free in all directions of gaze.

Visual acuity also improved to 6/9

DISCUSSION

The treatment given to the patient was only prophylactic. Her condition resolved spontaneously.

Orbital hemorrhage following trivial trauma at a site outside the orbit and spontaneous orbital hemorrhages are very rare and resolve spontaneously.

References

1. Mueller W, and Geppert, J., 1968 Klin. MbIAugenheik, 153: 795

2. Gillum, W.N. and Anderson, RL: Reversible visual loss in subperiosteal hematoma of orbit.

Ophthalmic Surg. 12:203, 1981 3. O'Neill, O.R., Delashaw , JB., and Phillips, J.P.:

Subperiosteal hematoma of the orbit associated with subfrontal extradural hematoma: case report.Surg. Neurol. 42:308, 1994

4. Choi, S., Lawson, W., and Urken, M.L.: Subperiosteal orbital hematoma. An unusual complication of sinusitis. Arch. Otolaryngol. Head Neck Surg. 114: 1464, 1988