An 8-year-old Afro-Caribbean girl presented with sudden bilateral proptosis and facial/scalp swelling. She had severe global developmental delay with a history of violent outbursts with physical contact. No evidence of trauma was found on slitlamp or full-body examination. A computed tomographic scan showed a large orbital subperiosteal collection, left greater than right proptosis, and bilateral frontal/parietal subgaleal scalp hematoma (Figure, A). Emergent bilateral lateral canthotomies and drainage of the subgaleal hematoma were performed. Coagulation factors were normal. After drainage, she had fixed, unresponsive, unequal pupils indicating that the optic nerves were compromised. A computed tomographic scan showed that the subgaleal hematoma had reoccurred (Figure, B). After another drainage of the hematoma and subperiosteal collection, the proptosis resolved and pupils became equal with response to light.
Lai M, Angunawela R. Sudden Bilateral Proptosis. JAMA Ophthalmol. 2016;134(10):e162112. doi:10.1001/jamaophthalmol.2016.2112