Spontaneous Retrobulbar Haematoma

Abstract

Background. Spontaneous orbital haemorrhage is a very rare condition and vision-threatening event. It may occur due to trauma, orbital surgery/injections, orbital vascular anomalies, and a variety of systemic predisposing factors. Signs of retrobulbar hemorrhage include proptosis, ophthalmoplegia, increased intraocular pressure, loss of pupillary reflexes, and optic disc or retinal pallor. Both Computed Tomography scan and Magnetic Resonance Imaging may be performed in the diagnosis. Case Report. A 31-year-old woman was referred to our hospital with a complaint of headache and blurred vision following a strong sneeze. Ophthalmological examination revealed mild Relative Afferent Pupillary Defect in left eye. Computed Tomography revealed left hyperdense retrobulbar mass and displaced optic nerve. T1 weighted hypointense, T2 weighted hyperintense and non-enhanced round shape, sharply demarcated lesion measuring 18 × 15 × 14 × mm in diameter compatible with haematoma was detected by MRI. Surgically Caldwell-Luc procedure was performed. Histological examination confirmed haematoma. Follow-up Magnetic Resonance Imaging revealed a small reduction in the size of lesion but not complete resolution. The patient's complaint was regressed. She is now free of symptoms and is still under surveillance. To our knowledge, this is the first reported case of retrobulbar haematoma caused by sneeze.

The Dangers of Sneezing: A Review of Injuries

“…The sites of injury were classified according to anatomical location: ocular/orbital [3][4][5][6][7][8][9][10][11][12][13][14][15] (27%), intrathoracic [16][17][18][19][20][21][22][23][24][25][26][27][28] (25%), intercranial/neurological 29-38 (19%), laryngeal/pharyngeal [39][40][41][42][43][44][45] (13%), otologic [46][47][48] (6%), and other [49][50][51][52][53] (10%) ( Figure 1). There were 15 cases orbital/ocular injury: orbital subcutaneous emphysema [3][4][5][6][7]10,11,…”

“…Deveer et al 11 Retrobulbar hematoma F 31 Sen and Chaturvedi 6 Orbital emphysema M 39 Ababneh 3 Orbital, subconjunctival, and subcutaneous emphysema M 16 Blunt trauma to left orbit hours before the sneezing episode Yilmaz et al 7 Blow-out fracture of right orbital floor which led to orbital emphysema and herniation of the orbital soft tissue…”

Spontaneous unilateral exophthalmos after a vaginal delivery

“…Some unusual causes may also be risk factors predisposing to orbital hemorrhage. A case of spontaneous retrobulbar hematoma caused by sneeze was reported by Deveer et al 5 The patient was treated surgically and resolution of clinical symptoms was obtained. Another case of subperiosteal hematoma in the orbit due to self-induced asphyxia was presented by Subiras et al 6 in a patient with non-accomplished suicide attempt.…”

Doubly Blinded: An Uncommon Cause of Acute Visual Loss Due to Orbital Compartment Syndrome

“…Proptosis with severe stabbing pain, vision loss, and a sensation of pressure are common. Patients may also experience nausea and vomiting, diplopia, and visual flashes [13]. External examination of the eye may reveal eyelid hematoma or ecchymosis, subconjunctival hemorrhage, proptosis, or ophthalmoplegia.…”