Session: Poster session C

Intraorbital haematoma during labor

Eline DE JONGH¹, D. KROEZE¹, D. TELGENHOF OUDE KOEHORST¹, K. ABHILLAKH MISSIER¹

¹Zorg Groep Twente (ZGT), Almelo, Netherlands

Introduction: A 31 year old woman complained about double vision during labor. Due to the rarity of this condition the diagnosis was not made immediately. Our aim is to raise awareness that an intraorbital haematoma can arise from venous hyperpression during labor. Early recognition and explanation to the patient will reduce the uncertainty and help the mother in this turbulent period of young motherhood.

Methods: Consult by the ophthalmologist and orthoptist was performed the same day at the maternity department. Full orthoptic examination took place 3 days postpartum.

Results: She wore an eyepatch on her left eye because of intractable diplopia in primary position and almost all directions of gaze. Only down/rightgaze was spared. One day postpartum there was a small haematoma from the left upper eyelid (nasally). The pupils were isocor, no RAPD. Funduscopy: normal. Slight exophthalmus OS (Hertel: 17-110-19). Orthoptic examination reveiled a small exotropia and small hypotropia of the left eye. Motility showed a small painfull restriction of elevation of the left eye. Visual acuity was good with her refractive correction.

MRI revealed an haematoma above the superior rectus muscle of the left eye. After 8 days she noticed a significant improvement of the diplopia and complete recovery occured after approximately 6 weeks.

Conclusions: Orthoptists and ophthalmologists need to be aware of this rare condition. Subperiostal orbital haemorrhage during labor has been described in literature and usually occurs

above the superior rectus muscle and can result in exophthalmos, restriction of elevation, painfull eyemovements, diplopia and vision loss due to optic nerve neuropathy. Recovery mostly occurs in the first 4 weeks, however also longer periods have been described up to 6 months. Our case had a relatively mild course. After two weeks there was no diplopia anymore in primary position. Vision was not affected. Nevertheless it had a great impact on her wellbeing.