PMC3032247_01
(A) Clinical photograph of the patient showing proptosis and downward displacement of the globe. (B) Computerized tomography scan photograph (coronal) showing a hypodense lesion measuring 3 x 2 x 1.2 cm superior to the optic nerve and superior rectus muscle. (C) Clinical photograph of the same patient 1 month after treatment of steroids showing complete resolution of proptosis. (D) Hess charting upper image showing restriction of movements in the right eye at the time of presentation and lower image showing normal movements after treatment
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Two similar cases of a 16-year-old and a 14-years-old male presented with protrusion of the right and left eye, respectively, with vertical diplopia, after sustaining trauma following a fall from height 20 and 10 days prior, respectively [Fig. 1A]. A computed tomography (CT) scan showed a hypodense lesion located superior to the optic nerve and superior rectus muscle and posteromedial to the globe with no bony discontinuity or fracture [Fig. 1B] thus confirming the diagnosis of posttraumatic SpH in both patients. After 1 month there was complete resolution of proptosis with the Hess chart showing normal EOM [Figs. 1C and D].
PMC3032247_02
(A) Clinical photograph of the patient showing proptosis and downward displacement of the globe. (B) Hess charting showing restriction of movements in the right eye. (C and D) Computerized tomography scan photograph (coronal and sagittal) showing a hypodense lesion in the superior quadrant of the right orbit measuring 3.2 x 2.7 x 1.4 cm, pushing the globe down and out. (E) Photograph of the same patient 1 week after aspiration of the hematoma. (F) Hess charting showing normal movements after treatment
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On examination, the patient had right eccentric proptosis with supra- and infra-orbital fullness [Fig. 2A]. Hess charting confirmed the motility defects [Fig. 2B]. CT scan showed a hypodense lesion in the superior quadrant of the right orbit pushing the globe down and out [Fig. 2C and D]. On the first postoperative day, the visual acuity was 20/20 with no proptosis and normal extraocular movements [Figs. 2E and F].
PMC3032247_03
(A and B) Clinical photograph of the patient showing the nonaxial proptosis and exposure keratopathy in the left eye with a lacerated wound over the left supraorbital ridge. (C, D and E) Computerized tomography scan (axial and coronal) showing superomedial orbital subperiosteal hematoma measuring 3.44 x 2.73 x 2.24 cm, in continuity with the subfrontal extradural hematoma measuring 5.75 x 4.53 x 3.30 cm through the undisplaced orbital roof fracture in the left side and displacing the globe downwards, laterally and forward. (F) Postoperative photograph 1 week after frontal craniotomy and superior orbitotomy showing complete resolution of proptosis
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On the left, there was an eccentric proptosis of 6 mm [Figs. 3A and B]. CT scan demonstrated a superomedial orbital SpH [Figs. 3C and D] in continuity with subfrontal extradural hematoma through the undisplaced orbital roof fracture in the left side [Figs. 3D and E]. The patient made an uneventful recovery with no neurological deficit, normal vision and fundus [Fig. 3F].