Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1689
Peer-review started: August 31, 2021
First decision: November 17, 2021
Revised: November 22, 2021
Accepted: January 8, 2022
Article in press: January 8, 2022
Published online: February 16, 2022
Processing time: 163 Days and 13.9 Hours
Orbital hemorrhage can be classified as traumatic or spontaneous depending on its cause. Spontaneous orbital hemorrhage refers to an internal orbital hemorrhage without apparent cause. Therefore, we aimed to describe a case of an orbital hematoma after a severe cough the night before due to inhalation of cooking oil fumes.
A 46-year-old woman was referred to our hospital with a complaint of exophthalmos accompanied with blurred vision, pain, binocular diplopia, and dizziness lasting for 5 h noted on waking in the morning. She also experienced nausea and vomiting due to high pressure of orbit and dizziness. Based on the auxiliary examination and her medical history, the patient was finally diagnosed with bulbar conjunctival vascular lesion combined with spontaneous retrobulbar hematoma. The patient was administered tobramycin and dexamethasone eye ointment, and applied pressure dressing on the left eye to stop the bleeding. Simultaneously, we administered intravenous etamsylate, oral Yunnan Baiyao capsule, intravenous mannitol to reduce orbital pressure, and intravenous dexamethasone injection at 10 mg/dL combined with neurotrophic therapy to reduce tissue edema. Among them, the Yunnan Baiyao capsule is a traditional Chinese herbal medicine to remove stasis and stop bleeding; thus, it promotes blood circulation and relieves pain resulting in reduced edema of the lesion site. The symptoms did not improve significantly during the first 2 d of treatment. We speculate that high orbital pressure and binocular diplopia induced frequent nausea and vomiting in the patient, causing increased pressure on the superior vena cava and leading to repeated orbital bleeding. After the second day, the symptoms started gradually improving.
This case further emphasizes the importance of comprehensive, detailed medical history and careful ophthalmic examination of the patient.
Core Tip: Orbital hemorrhage can be classified as traumatic or spontaneous according to its cause. Spontaneous orbital hemorrhage is an extremely rare and vision-threatening condition that may occur due to a variety of systemic predisposing factors. This case report suggests that patients with malformed periorbital vasculature should be alert for the risk of spontaneous intraorbital hemorrhage. In previous literature, we found reports of retrobulbar hematomas caused by sneezing or vomiting. However, to our knowledge, this is the first reported case of apparent bulbar conjunctival vascular malformation combined with retrobulbar hematoma caused by severe coughing.