Spontaneous retrobulbar haemorrhage in idiopathic thrombocytopenic purpura

Sousa, Filipa Caiado; Medeiros, Joana Pinto; Marques, Raquel; Marques-Neves, Carlos

doi:10.1136/bcr-2017-223028

Cited by 4 publications

(3 citation statements)

References 3 publications

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“…3 Cases of spontaneous retrobulbar hemorrhage due to underlying coagulopathy have been reported in patients with Vitamin K deficiency, dabigatran use, idiopathic thrombocytopenic purpura, hemophilia A, scurvy, and warfarin use. [4][5][6][7] The majority of reported cases are unilateral. This is, to our knowledge, the first reported case of spontaneous bilateral retrobulbar hemorrhage due to warfarin misuse.…”

Section: Discussionmentioning

confidence: 99%

Tendon-Sparing Extraocular Muscle Enlargement Associated With Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Dimopoulos,

Barmettler

2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an inflammatory, sensorimotor polyneuropathy. It has presented with a variety of orbital and neuro-ophthalmic manifestations, including cranial nerve hypertrophy and a single case of extraocular muscle enlargement. The authors present a second case of tendon-sparing, extraocular muscle enlargement, resulting in new-onset diplopia and strabismus in a teenager with CIDP. The workup ruled out alternative causes of extraocular muscle enlargement, such as hyperthyroidism, inflammation, or malignancy. As with other cases of CIDP, management involved a combination of immunoglobulin therapy and anti-inflammatory medications. The patient experienced resolution of his symptoms, and radiologic improvement was noted in the muscle enlargement. As many CIDP patients have a favorable treatment response and long-term prognosis, awareness of this rare disease with an early and accurate diagnosis is important.

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Section: Discussionmentioning

confidence: 99%

Tendon-Sparing Extraocular Muscle Enlargement Associated With Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Dimopoulos,

Barmettler

2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…3 Cases of spontaneous retrobulbar hemorrhage due to underlying coagulopathy have been reported in patients with Vitamin K deficiency, dabigatran use, idiopathic thrombocytopenic purpura, hemophilia A, scurvy, and warfarin use. 4–7 The majority of reported cases are unilateral. This is, to our knowledge, the first reported case of spontaneous bilateral retrobulbar hemorrhage due to warfarin misuse.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Spontaneous Retrobulbar Hemorrhage due to Warfarin Misuse After Sinus Lavage

Kates,

McNelly,

Fischer

et al. 2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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While warfarin has historically played an important role in anticoagulation, direct oral anticoagulants have largely supplanted warfarin due to their improved safety profile and reduced need for monitoring. Herein, the authors report the case of a 64-year-old male who developed severe, bilateral retrobulbar hemorrhage following aggressive nasal lavage due to a supratherapeutic international normalized ratio from warfarin misuse. Visual acuity on arrival was hand-motion OD and no-light-perception OS. He underwent bilateral canthotomy with upper and lower lid cantholysis before transfer to a trauma center where his international normalized ratio was greater than 12. Reversal with vitamin K and prothrombin complex concentrate was initiated. Over the course of hospitalization, vision and swelling continued to improve and at 2-month follow-up his visual acuity was 20/20 OD and no-light-perception OS. This case outlines the risk of bleeding associated with warfarin misuse and advocates for the transition of patients to direct oral anticoagulants when possible.

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“…2,3,8,9 Additionally, spontaneous RBH may be related to changes in coagulation, such as warfarin toxicity, heparin treatment, scurvy, idiopathic thrombocytopenic purpura, breast cancer, and systemic thrombolytic agents. [10][11][12][13][14][15][16][17] In a case series with 115 cases of spontaneous RBH presentations, about 90% of these cases were due to orbital vascular malformations, and about 10% were due to predisposing factors such as coagulopathies, hypertension, or activities that can increase strain or intra-abdominal pressure. 1 The coagulopathies examined include deep venous thrombosis, Henoch-Schonlein purpura, and elevated prothrombin and partial thromboplastin times without a specific coagulation diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Lateral Canthotomy and Cantholysis for Spontaneous Retrobulbar Hemorrhage With Normal Intraocular Pressures: Case Report and Review of the Literature

Lem

Oyur

LaBove

et al. 2022

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Spontaneous retrobulbar hemorrhage (RBH) is uncommon and typically occurs secondary to vascular malformations, coagulopathies, hypertension, or strenuous activities in the setting of elevated intraocular pressure (IOP). RBH can cause orbital compartment syndrome (OCS) with resultant permanent vision loss. We present a case of spontaneous RBH in an 18-year-old male with a history of acute lymphoblastic leukemia (ALL) and sepsis. While IOPs were normal, the patient exhibited symptoms of OCS in which a lateral canthotomy and cantholysis were performed. This case highlights the importance of the clinical exam when treating a patient with suspected OCS and demonstrates that intraocular pressures need not be elevated for both diagnosis and intervention.

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Spontaneous retrobulbar haemorrhage in idiopathic thrombocytopenic purpura

Cited by 4 publications

References 3 publications

Tendon-Sparing Extraocular Muscle Enlargement Associated With Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Tendon-Sparing Extraocular Muscle Enlargement Associated With Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Bilateral Spontaneous Retrobulbar Hemorrhage due to Warfarin Misuse After Sinus Lavage

Lateral Canthotomy and Cantholysis for Spontaneous Retrobulbar Hemorrhage With Normal Intraocular Pressures: Case Report and Review of the Literature

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