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Clinicopathologic Reports, Case Reports, and Small Case Series
October 2002

Bilateral subperiosteal Orbital Hematomas and Henoch-Schönlein Purpura

Arch Ophthalmol. 2002;120(10):1398-1399. doi:

There are few reports of nontraumatic bilateral subperiosteal orbital hematomas in the ophthalmic literature.1-3 None exist on subperiosteal orbital hematomas associated with Henoch-Schonlein purpura.

A 5-year-old boy with a known case of infantile spasms since birth visited with bilateral exophthalmos of a few days' duration. Ocular examination revealed bilateral upper eyelid ecchymosis and exophthalmos mostly on the right side, with no afferent pupillary defect (Figure 1). There was no history of trauma. Physical examination revealed a purpuric rash on the buttocks and lower extremities, abdominal tenderness, and bilateral ankle swelling and tenderness. Computed tomography (CT) scans of the orbits revealed well-defined, nonenhancing, bilateral superior orbital masses with no bone erosion (Figure 2). Hematuria was noted on urinalysis, but systemic workup, including coagulation studies, was normal. A diagnosis of Henoch-Schönlein purpura with bilateral orbital hematomas was entertained. Orbital magnetic resonance imaging (MRI) at follow-up confirmed the diagnosis and showed improvement. There was an uneventful recovery, with marked resolution of the exophthalmos 2 weeks following initial visit.

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