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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 170-171

Bane of consanguinity - Vision-threatening orbital sub-periosteal haematoma in hypofibrinogenaemia


Department of Ophthalmology, Ramaiah Medical College Hospital, Bengaluru 560 054, Karnataka, India

Date of Submission20-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
G P Thanuja
Department of Ophthalmology, Ramaiah Medical College Hospital, Bengaluru 560 054, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2264_19

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How to cite this article:
Thanuja G P, Namrata D. Bane of consanguinity - Vision-threatening orbital sub-periosteal haematoma in hypofibrinogenaemia. Indian J Med Res 2020;152, Suppl S1:170-1

How to cite this URL:
Thanuja G P, Namrata D. Bane of consanguinity - Vision-threatening orbital sub-periosteal haematoma in hypofibrinogenaemia. Indian J Med Res [serial online] 2020 [cited 2021 Jul 30];152, Suppl S1:170-1. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/170/316802

The child's assent and parents' consent obtained to publish clinical information and images.


A nine yr old male child, born of second-degree consanguineous marriage, was diagnosed with congenital hypofibrinogenaemia seven years back. He presented with progressive right eye proptosis with exposure keratopathy following trivial trauma to the forehead in September 2018, at the department of Ophthalmology, Ramaiah Medical College & Hospital, Bengaluru, India. Computed tomography of the brain showed hyperacute subgaleal and right orbital subperiosteal haematoma of about 35 × 29 × 17 mm in size. Blood parameters revealed fibrinogen levels <10 mg/dl, prothrombin time >120 sec, activated partial thromboplastin time >120 sec and thrombin time >120 sec. Cryoprecipitate infusion was given to stabilize blood parameters. When fibrinogen levels were >200 mg/dl, wide bore needle aspiration of subperiosteal haematoma (Video) and lateral tarsorraphy was done to reduce proptosis and protect cornea. The patient improved with vision of 6/12 after one month.
Figure 1: (A) The patient on presentation after trivial trauma to the forehead, with swelling seen on the right eye. (B) Increased intraorbital swelling causing severe proptosis with exposure keratopathy causing decrease in vision. (C) Computed tomography orbit showing hyperdense biconvex lesion in the superior orbit, suggestive of subperiosteal haematoma with the orbital roof intact. (D) After wide-bore needle aspiration, drain was put as there was continuous bleed. (E) Postoperative one-week proptosis completely reduced with resolving corneal infiltrates. (F) At one-month follow up, the patient had an inferior corneal opacity with vision of 6/12.

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Orbital subperiosteal haematoma is a rare presentation following trivial trauma and is usually self-limiting and rarely requires intervention. In bleeding diathesis, orbital subperiosteal haematoma if not aggressively managed may lead to visual loss.

Acknowledgment: Authors acknowledge Dr Somshekhar, department of Peadiatrics, and Dr P. Rashmi, Hemato-Oncologist for participating in patient management.

Conflicts of Interest: None.


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