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| CASE REPORT |
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| Year : 1982 | Volume
: 30
| Issue : 1 | Page : 51-52 |
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Subperiosteal hematoma of the orbit
SP Dhir, VP Munjal, N Staneezae, IS Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Correspondence Address:
S P Dhir
Department of Ophthalmology, P.G.I. Chandigarh-160 012
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 7141587 
How to cite this article:
Dhir S P, Munjal V P, Staneezae N, Jain I S. Subperiosteal hematoma of the orbit. Indian J Ophthalmol 1982;30:51-2 |
A blunt trauma to the head may result in a subperiosteal hematoma of the orbit. It is rare and not many cases have been reported in the literature. The roof of the orbit is most commonly involved and is more often seen in young people[2]. Three cases of sub-periosteal hematomas have been reviewed by Wolter[3]. They are liable to produce many complications if not managed timely. We report a young boy who developed acute proptosis following blunt head trauma which endangered the eye.
| Case report | |  |
H.R. (A036365): 17 years old male boy was injured while riding on a bicycle. He was hit on the right side of the forehead by an elbow of his friend sitting in front of him. He developed swelling and ecchymosis of the right side of the face. The swelling subsided in two days time and the patient noted protrusion of the right eye ball. He was treated conservatively by the local ophthalmologist. There was not much improvement in the condition. He was seen by us after 15 days of the accident. There was no history of unconsciousness or bleeding from any site. On examination, there was discoloration of the right upper lid. There was 7mm. proptosis of the right eye ball. The eyeball was displaced forward and downward. [Figure - 1] Prolapsed lacrimal gland could be palpated as a lobulated mass in the upper and outer angle of the orbit. A diffuse mass was felt in the upper and inner angle which was tender on deep pressure. Eye movements were grossly restricted in the upward direction and there was some limitation of adduction and abduction [Figure 2]. Bulbar conjunctiva was chemosed in the lower half. Cornea was clear. Pupil was well reacting and fundus was normal. Visual acuity was 6/9 in the right eye and 6/6 in the left eye. Visual fields were full. Left eye was normal. X-ray of the right orbit showed a diffuse soft tissue shadow and there was no bony fracture. Bleeding and clotting time of the blood was within normal limits.
Proptosis increased during his stay in the hospital and the patient developed mild, exposure keratitis. He was diagnosed as a case of Subperiosteal hematoma as the proptosis appearance after injury to the supraorbital region, its direction and fluctuation in the size. An aspiration with 18 gauze needle was attempted. No blood was found in the peripheral orbital space. The needle was thrust into the thick membrane walling the mass, it entered into a cavity and l Oml. of altered blood could be aspirated. The proptosis disappeared simultaneously with the aspiration of the blood. [Figure - 1] All movements recovered [Figure 2] except slight restriction of elevation which also recovered in a weeks time. Patient was given injection Streptopenicillin I gm. I/m daily for 5 days to guard against infection
| Discussion | | |
This case presented with typical signs of subperiosteal hematoma without any associated injury to the skull and brain. Minimal trauma is known to produce subperiosteal hematoma of the roof of the orbit. A somewhat delayed occurrence is the typical feature of subperiosteal hematoma[3]. An increase in proptosis in the ward after 18 days of the accident pointed to a recurrent bleed which is an unusual feature seen in this case. The exact time of occurrence in our case is not clear because of swelling of the lids in the initial period and the actual protrusion of the eye ball was noticed by the patient two days later when the swelling subsided.
Most of the cases reported in the literature[3] are young males and our patient is also a young male. Two possible explanations have been offered, one is the more exposure of males for accidents and the other could be that the orbital periosteum of the young males is more vulnerable for detachment[3]. Whatever, the cause may be, it is important to recognise the condition and treat it early. Simple procedure of needle aspiration with all aseptic precautions gives satisfactory results and saves the eye from dreaded complications.
| Summary | | |
A young body who developed acute proptosis following blunt head trauma which] endangered the eye. He was diagnosed as a case of subperiosteal haematoma of the orbit. Aspiration of 10ml. of altered blood from the haematoma led to resolution of proptosis.
| References | | |
| 1. | Mueller W, and Geppert, J., 1968 Klin. MbIAugenheik, 153: 795.  |
| 2. | Robert, W., 1955, Amer, J. Ophthalmol. 40;215, |
| 3. | Wolter, J.R., 1979, J. Paediat. Ophthalmol. & Strab. 16, 291. |
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