Paediatric Orbital Bleeding with Paul Glaucoma Implant: A Case Report
Author: Alberto Chierigo
Base Hospital / Institution: Department of Ophthalmology, San Martino Hospital – University of Genova, Genova, Italy
ePoster presentation
Abstract ID: 24-391
Purpose
Paul glaucoma implant is novel drainage device in paediatric glaucoma. We discuss a case of acute orbital haemorrhage following insertion of this implant.
Methods
A 10-year-old boy with Axenfeld-Rieger-syndrome-associated glaucoma underwent Paul implant to his right eye. Four days later, he presented with symptoms of right eye pain and lid swelling. There was no history of trauma.
Results
Repeated clinical examination showed progressive reduction of visual acuity (to hand movements) and reduced colour vision in his right eye. Pupillary reactions were sluggish without relative afferent pupillary defect. The right eye was proptosed with ecchymosis of lids, subconjunctival haemorrhage and restricted eye movements. The initial intraocular pressure (IOP) was 50 mmHg. The anterior chamber was deep with no intraocular bleeding. Orbital haemorrhage was suspected and immediately treated with topical and intravenous IOP-lowering agents, with subsequent lateral canthotomy and cantholysis, which improved pain, proptosis, eye movements and reduced IOP.
Despite this, subsequent bleeding was noted from lateral canthal wound with a tense orbit. Repeat CT orbits still showed subconjunctival and intraconal haematoma abutting optic nerve apex. Urgent surgical evacuation of haematoma found a linear scleral wound at the posterior border of the implant with bleeding from underlying choroid. The scleral wound was self-sealing, and implant was left in place. Further medical management allowed maintenance of IOP 11mmHg and Snellen vision of 6/9.
Conclusion
Orbital haemorrhage following glaucoma device is rare. Suprachoroidal haemorrhage and choroidal effusion are recognised complications, but scleral breach has not been previously reported. This case demonstrates the importance of anatomical and physiological considerations, with systematic management of orbital haemorrhage in the presence of a glaucoma drainage device.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Marucs | Lim | Eye Unit, University Hospital Southampton, Southampton, UK |
| Bhavna | Sharma | Eye Unit, University Hospital Southampton, Southampton, UK |
| Daniele | Lorenzano | Eye Unit, University Hospital Southampton, Southampton, UK |
| Richard | Imonikhe | Eye Unit, University Hospital Southampton, Southampton, UK |
| Varajini | Joganathan | Eye Unit, University Hospital Southampton, Southampton, UK |
