Spontaneous Medial Rectus Haematoma: A Sight-Threatening Complication of Warfarin Toxicity

This report highlights a rare instance of spontaneous medial rectus haematoma in a 77-year-old female, attributed to warfarin use, underscoring its clinical significance. The patient initially presented with acute right eye pain, peri-orbital swelling, and reduced vision. Examination revealed a tense globe and elevated intraocular pressure (IOP), prompting emergency lateral canthotomy and inferior cantholysis. However, despite the initial procedure, her IOP remained elevated, indicating direct pressure from the haematoma on the globe and necessitating additional upper and lower eyelid lateral cantholysis. Medical management was also initiated to control the IOP. Over four months, the patient's visual acuity improved significantly, although a relative afferent pupillary defect persisted. This case underscores the rarity of spontaneous medial rectus haematoma in anticoagulated patients and highlights the critical importance of vigilant international normalized ratio (INR) monitoring and timely intervention to reduce morbidity and the risk of vision loss.