Spontaneous orbital haemorrhage into the lateral rectus muscle

Spontaneous orbital haemorrhage can occur at any age. The clinical presentation is often dramatic with acute painful proptosis and nausea. Vision may be severely impaired.

A 77 years old lady woke up with sudden retroocular pain, diplopia and proptosis. Her blood pressure was 235 / 95 mmHg. MRI showed a right retroocular mass, contiguous with the lateral rectus muscle and consistent with a haemorrhage. Vision was preserved in both eyes but the right visual field slightly altered. Motility of the right eye was severely impaired.

The risks of surgical drainage were considered too high in a case of only slight visual field impairment, and a conservative attitude was decided. Evolution was good with antihypertensive treatment, the haemorrhage resorbed and diplopia improved. MRI showed no morphological orbital anomaly.

Spontaneous orbital haemorrhage is a complication of a vascular orbital anomaly in most cases, more rarely due to a disturbance of coagulation. In our case arterial hypertension in association with antiaggregant intake explains the haemorrhage. Conservative treatment appears adequate with regard to the only slight visual field impairment. Close neuro-ophthalmological follow-up is, however, needed.