A 13-YEAR-OLD white girl had an 18-hour history of spontaneous right proptosis (Figure 1) and significant periorbital and retrobulbar discomfort. This had developed while she was resting quietly. She had not recently taken aspirin, nonsteroidal anti-inflammatory drugs, or anticoagulants.
She had a 2-month history of increasingly severe lower leg pain that necessitated the use of a wheelchair and a 1-month history of bleeding gums (Figure 2), both of unknown cause. Results of a recently performed gum biopsy were unremarkable. She was known to have thalassaemia major, treated with repeated blood transfusions. Thalassaemia is not usually associated with coagulation abnormalities, and extensive testing revealed no evidence of coagulopathy.
Sloan B, Kulwin DR, Kersten RC. Scurvy Causing Bilateral Orbital Hemorrhage. Arch Ophthalmol. 1999;117(6):842-843. doi:10.1001/archopht.117.6.842