A HEALTHY 20-month-old boy was referred to the ophthalmology department with a swelling in the upper medial part of the orbit (Figure 1). Four weeks prior to this visit, the patient was hit by a small soft plastic flying disk (approximately 10.1 cm [4 in] in diameter) skimmed across the water of a swimming pool. He subsequently developed upper eyelid bruising on the right eye. On palpation, the swelling was firm and fixed, displacing the globe inferiorly and laterally. A magnetic resonance imaging scan of the right orbit showed a 3×2×2-cm extraconal mass that was hyperintense on the fluid-attenuated inversion recovery (FLAIR) and T2-sequence and was isotense with the muscle, suggesting a hematoma (Figure 2). Initial screening showed prolonged activated partial thromboplastin time due to reduced factor XII. Factor XII is required for normal in vitro clotting times, but is not essential for efficient clotting and is not associated with a bleeding diathesis. Platelet function testing results were abnormal, showing reduced aggregation and disaggregation with adrenaline and no aggregation with arachadonic acid.1 The patient's hematoma was drained with a 21-gauge needle. The operation was covered with platelet infusion and tranexamic acid, an antifibrinolytic drug that inhibits plasminogen activation.2 Postoperative recovery was uneventful, with no further bleeding (Figure 3).
Khan MA, Thomas AE, McIlwaine G. Orbital Hematoma Following Minor Trauma Due to Platelet Aggregation Abnormality. Arch Ophthalmol. 1998;116(10):1402–1403. doi:10.1001/archopht.116.10.1402
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