[Spontaneous hematoma of the intra-orbital optic nerve]

A young male was observed with papilledema and optic nerve enlargement on CT scanning. Visual acuity and field were not affected. A microsurgical procedure, through a para-latero-nasal approach, revealed a blue domed cyst around the neural structure. Incision of the cyst released old hemorrhagic fluid and biopsies of the cyst wall were collected. Microscopy showed granuloma and hemosiderin pigments. The post-operative course was uneventful, and the papilledema resolved in six weeks. The clinical presentation and surgical findings, the histopathology and the post-operative course lead us to conclude that this is a case of spontaneous hematoma of the optic nerve. Although intracranial and chiasmal optic nerve hematomas have been described since 1966, this is the first report to our knowledge of a hematoma involving the intraorbital portion of the optic nerve. The para-latero-nasal approach seems to be a easy way of acquiring good visualization without any osteotomy, when an operating microscope is available. This report may alert ophthalmologists to consider a cyst as a rare cause of papilledema.