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Epistaxis01:30

Epistaxis

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Epistaxis, or nosebleeds, occurs when small, swollen blood vessels in the nasal mucous membrane rupture. Typically, the anterior septum is the primary site of occurrence.
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A postpartum woman experienced sudden vision loss due to a lateral rectus hemorrhage. Prompt surgical intervention and hematoma evacuation successfully restored her vision and eye function.

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Area of Science:

  • Ophthalmology
  • Neuro-ophthalmology
  • Emergency Medicine

Background:

  • Sudden vision loss and orbital symptoms in postpartum women can indicate serious orbital pathology.
  • Lateral rectus muscle hemorrhage is a rare but critical condition requiring urgent diagnosis and management.

Observation:

  • A postpartum patient presented with acute left eye pain, proptosis, ophthalmoplegia, and vision loss.
  • Clinical findings included resistance to globe retropulsion and a relative afferent pupillary defect (RAPD).
  • CT and MRI revealed a retrobulbar enhancing lesion consistent with lateral rectus hemorrhage causing significant mass effect.

Findings:

  • Emergency lateral canthotomy and cantholysis were performed, followed by orbitotomy and hematoma evacuation due to persistent visual deficit.
  • Postoperatively, visual acuity improved to 6/6, eye movements normalized within two weeks, and imaging showed near-complete hematoma resolution.

Implications:

  • This case highlights the importance of prompt recognition and aggressive surgical management of lateral rectus hemorrhage.
  • Timely intervention can prevent permanent vision loss and restore ocular function in critical orbital emergencies.
  • Orbital hematomas, particularly in the postpartum period, warrant a high index of suspicion and multidisciplinary management.