Abstract Listings 2024

Purpose

Spontaneous orbital hematomas are rare, especially in adults. They produce proptosis and often diplopia and restriction of the motility of the extraocular muscles. Diagnosis is radiological by TC or MRI.

Methods

5-year-old woman presenting to the emergency department for proptosis of the left eye, abrupt headache, nausea and vomiting. History: migraines, no previous trauma, no vascular risk factors. Examination showed left inferior orbital hematoma, slight exophthalmos, deficit of motility in supraversion of the left eye and vertical diplopia. The visual acuity was 1 in both eyes, the rest of the ophthalmologic and analytical examination without alterations. The MRI showed a lesion in the left inferior rectum (IR), very posterior, localized and with hyperintense rim that also affected the internal rectum. Rest and systemic anti-inflammatory drugs were prescribed.

Results

after a week, the patient only had slight diplopia in supraversion and a left inferior orbital hematoma. A new MRI was performed one month after the episode and the lesion has returned.

Conclusion

Orbital hematoma is a rare entity, sometimes associated with valsalva maneuvers, previous trauma, vascular risk factors such hypertension, hyperlipidemia, use of antiplatelet drugs, and radiological exclusion of underlying vascular malformations or any other lesion should be ruled out. Idiopathic spontaneous hematoma is diagnosed when there is no such history. Hematomas have been described in the extraocular muscles, where most of them are located in the IR, as in our patient, and also subperiosteal intraorbital hematomas. The radiological study is determinant for its diagnosis and control. Generally these lesions return spontaneously, although there is the possibility of surgical intervention if the pathology persists.

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