Presentation
History of trauma due to a fight. Symptoms of diplopia with limitation adduction of the left eye.
Patient Data
CT demonstrates an elliptical hyperdense shaped collection in extraconal space of medial superior quadrant of the left orbit. No septations within the collection. No fracture of the adjacent bones. No intraconal or intracranial extension.
The findings and patient's history are most in keeping with an orbital subperiosteal hematoma.
Case Discussion
Orbital hematomas have been classically described as either intraorbital or subperiosteal in nature. Intraorbital (ie, retrobulbar) hematomas are observed in the setting of craniomaxillofacial trauma and/or orbital approaches; data reporting their occurrence are sparse, with an estimated incidence of 0.3%.
Orbital subperiosteal hematomas (OSPHs) are less common; occurring primarily in young males as a direct result of craniomaxillofacial trauma, although the development of spontaneous OSPH has been reported. The etiologies of OSPH may be divided into 4 subcategories: congestive, traumatic, spontaneous, and systemic. Despite these findings, there remains a paucity of primary literature addressing the appropriate management of this complex disorder. Currently described treatment options for traumatic OSPH include conservative management, needle aspiration, or surgical intervention.
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