Acute orbital hemorrhage as a presentation of a lytic bony lesion

Abstract

A 61-year-old Chinese man presented to the emergency department with a 1-day history of painful swelling of the right eyelid with loss of vision. He had been treated earlier for an isolated pathological fracture of the T7 vertebra from plasmacytoma. Computed tomography was suggestive of superior orbital hematoma with bony erosion of the inner and outer tables of an isolated frontal cell, and urgent drainage of the hematoma resulted in relief of the pain and improvement of the vision. A formal orbitotomy was performed to evacuate the hematoma, followed by combined endoscopic sinus surgery and external anterior frontal table trephine to connect the isolated cell to the frontal sinus. The histology did not show evidence of myeloma, and the orbital hematoma was probably a result of an acute hemorrhage into the mucocele of an isolated cell in the frontal bone. However, in patients with a history of multiple myeloma, it is important to consider lytic bony involvement as the cause of an orbital hemorrhage.

Keywords: Multiple myeloma; hematoma; orbit.

Figure 1

Right upper-lid swelling without erythema.

Figure 2

Computed tomography of the patient showing (A) right isolated frontal cell with osteolytic lesion opening to the orbit, (B) osteolytic opening to the anterior cranial fossa, (C) fluid level in the homogenous lesion of the right superolateral orbit.