Related Experiment Video
Updated: Jun 8, 2026
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Posttraumatic subperiosteal hematomas of the orbit in children
1Department of Ophthalmology, Uludag University, Bursa, Turkey. byazici@uludag.edu.tr
Insights
Pediatric orbital subperiosteal hematomas commonly result from blunt trauma, often affecting the superior orbit. Surgical evacuation is the typical treatment, though observation is sometimes appropriate for these traumatic orbital injuries.
Area of Science:
- Ophthalmology
- Pediatric Traumatology
- Neuroradiology
Background:
- Orbital subperiosteal hematomas are rare in children, often resulting from trauma.
- Understanding their presentation and management is crucial for pediatric care.
Observation:
- A review of 5 pediatric cases and 23 literature cases revealed male predominance (78%) and a mean age of 12 years.
- Blunt trauma, particularly falls, was the primary cause.
- Hematomas predominantly occurred in the superior orbit, with some extending into intracranial spaces.
Findings:
- Compressive optic neuropathy occurred in 30% of cases, with higher risk in bilateral or extensive hematomas.
- Surgical evacuation (74%) was the most common treatment, followed by observation (22%).
- Recurrence was noted in 13% of patients.
Implications:
- Prompt diagnosis and management of pediatric orbital subperiosteal hematomas are essential to prevent vision loss.
- Identifying risk factors like coagulopathy and associated injuries aids in treatment decisions.
- Further research into optimal management strategies for complex cases is warranted.
Purpose:
To describe 5 pediatric patients with traumatic orbital subperiosteal hematoma and review the relevant literature.
Methods:
Retrospective chart analysis of 5 children with posttraumatic subperiosteal hematoma and a systematic review of the English language literature.
Results:
Five new pediatric cases of orbital subperiosteal hematoma are presented with varying clinical and radiologic manifestations and treatments. Literature review (including the current 5 cases) yielded 23 cases in total. Eighteen (78%) of the patients were boys, and 5 (22%) were girls. The children ranged in age from 5 to 17 years, with the mean and median ages being 12 years. The leading cause was blunt trauma related to falls or direct impact. Two patients (9%) had an inherited coagulopathy, predisposing them to orbital hemorrhage. The hematomas developed in the superior orbit in all cases except one. In 3 patients (13%), orbital hematomas were bilateral. In 9 patients (39%), the hematomas extended in subgaleal or frontal subdural spaces. In 7 patients (30%), subperiosteal hematoma was associated with compressive optic neuropathy. Four patients (17%) had a nondisplaced orbital roof fracture. Seventeen patients were treated with surgical evacuation of hematoma (52%) or with needle aspiration (22%), and 5 patients (22%) were observed for spontaneous resolution. Three patients (13%) experienced a recurrence of hemorrhage.
Conclusions:
In children, traumatic subperiosteal hematomas of the orbit typically occur after blunt trauma in the superior orbit. The risk of compressive optic neuropathy may be higher in patients with bilateral hematoma and massive subgaleal hematoma. Most patients are treated with evacuation of the hematoma.
