Abstract
Purpose :
Non-traumatic spontaneous orbital hemorrhage without underlying vascular malformations or predisposing conditions is uncommon, and particularly rare in the context of maternal labor. This study combines a novel case report and retrospective review to analyze reported cases and propose insights into underlying mechanisms, common features, and management guidelines.
Methods :
This study is both a unique case report and review examining PubMed publications (1996-2023) with articles traced back to original sources through citations for inclusion. Analysis included clinical presentation, visual examination, hematoma characteristics, neuroimaging, management strategies, and outcomes.
Results :
We present a 37-year-old multigravida woman at 40w0d who developed acute right-sided proptosis, diplopia, retrobulbar pain, and periorbital edema during the second stage of labor following an uncomplicated antepartum course. CT imaging revealed a retrobulbar hematoma, with subsequent MRI ruling out vascular anomalies. Symptoms resolved two months after onset. Only 14 cases of maternal orbital hematoma have been reported with varying details. Average age was 28 with 42% being primigravid. Forty percent (6/15) developed symptoms during the second stage of labor, 40% immediately postpartum, and 20% over 24 hours postpartum. Overall, 36% (5/15) had potentially contributing conditions such as coagulopathies, delivery complications, or vascular malformations. Unilateral orbital hemorrhage occurred in 86.7% (13/15). Surgical intervention was necessary in 13.3% of cases (2/15), which were both associated with bilateral involvement, obstetric complications, and limited visual recovery. The majority (86.6%) underwent observation or medical management with full recovery of symptoms.
Conclusions :
Non-traumatic orbital hematomas associated with maternal labor are rare and may be related to increased Valsalva during delivery and heightened blood volume in pregnancy. Neuro-imaging and systemic workup are recommended to assess for vascular anomalies or underlying coagulopathies. Caution is advised, particularly in cases with obstetric complications, as they correlated with more severe symptoms requiring surgical intervention and long-term visual consequences. Given these considerations, the overall prognosis is favorable with most having full recovery.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.