Nontraumatic subperiosteal orbital hemorrhage

Purpose: Nontraumatic subperiosteal orbital hemorrhage (NTSOH) has been rep orted rarely in association with sudden elevation of cranial venous pressur e, generalized diseases with bleeding diatheses, and paranasal sinusitis. T o define more clearly the clinical and imaging characteristics of NTSOH, we evaluated nine cases seen by the authors and reviewed previous case report s. Design: Retrospective, noncomparative case series. Participants: Nine patients (10 eyes) with NTSOH, Intervention: Ail patients underwent computed tomography scans of the orbit s. Patients with typical clinical and imaging features and normal visual fu nction were observed. Those with an uncertain diagnosis or visual compromis e underwent surgical drainage of the hematoma. Main Outcome Measures: Resolution of proptosis, diplopia, lid swelling, and ptosis, Results: Nine patients ranging from birth to 73 years of age were identifie d. All were females. The lesions were located superiorly in eight patients tone patient had bilateral lesions) and medially in one patient. Most were associated with sudden elevation in venous pressure (vomiting, strangulatio n, straining), and most required no surgical intervention. The bilateral ca se occurred in the setting of disseminated intravascular coagulation and wa s the only case associated with visual loss possibly resulting from ischemi c optic neuropathy. Conclusions: Nontraumatic subperiosteal orbital hemorrhage may occur at any age, usually secondary to sudden elevation in venous pressure. it is nearl y always superior. The clinical and radiologic features are sufficiently ch aracteristic to allow conservative treatment in the absence of visual compr omise. Ophthalmology 2001;108. 183-189 (C) 2001 by the American Academy of Ophthalmology.