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Abstract
Purpose
Orbital varices, which can lead to proptosis or globe displacement, are caused by Valsalva’s maneuver or bending forward. Most of the orbital varices are treated conservatively, but surgical treatment is necessary for severe cosmetic or func-tional problems. We report a case of orbital organizing hematoma accompanied by an orbital varix which was successfully re-moved surgically without complications such as intraoperative bleeding.
Case summary
A 78-year-old female presented with the complaint of 4 mm proptosis and hyperglobus of left eye. Orbit mag-netic resonance imaging (MRI) showed a well demarcated extraconal mass in the inferior orbit which appeared to be an orbital varix. Initially, we decided to monitor the patient without surgery because proptosis was reduced to 1 mm within a week. However, after 5 months, the symptoms suddenly worsened, specifically, 4 mm of proptosis with severe hyperglobus and pain. MRI showed a 29.7 × 21.2 × 23.7 mm mass compressing the globe upward. Six weeks of conservative care did not improve the symptoms and we eventually performed an anterior orbitotomy through the inferior conjunctiva. There was a minor bleeding dur-ing the surgery. Based on the histological test, the mass was determined to be an organizing hematoma covered by a membrane. At 8 months postoperatively, symptoms had not recurred.
Conclusions
Orbital varices are usually treated conservatively since its surgical removal is known to have risks. Nonetheless, if an MRI shows an orbital organizing hematoma, it can be surgically debulked successfully without complications when a chronic hemorrhage from orbital varix causes serious proptosis and globe deviation.
References
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Figure 1.
Patient photographs at initial visit and 5 months after. (A, B) External photograph shows left exophthalmos and upward displacement of the left eye at initial visit. (C, D) 5 months later, aggravation of the left exophthalmos and hyperglobus was noted.
Figure 2.
Orbital magnetic resonance imaging (MRI) at initial visit and 5 months after T1 and T2 weighted gadolinium enhanced orbital MRI. Initial visit, 25.5 × 13.7 × 21.1 mm sized enhancing tubular lesion with non-enhancing lesion showing T1 high signal intensity (A, B), T2 heteroge-neous signal intensity (C, D) was found at inferior orbit. 5 months later, increased size of the lesion to 29.7 × 21.2 × 23.7 mm, showing decreased T1 signal intensity (E, F), heterogenous T2 signal intensity, and newly appearing heterogenous enhancement with capsule of high signal intensity (G, H) was seen. Inferior rectus muscle and left globe was deviated without adjacent structure invasion.
Figure 3.
Surgical photograph of anterior orbitotomy and pathologic findings of excised orbital organized hematoma. (A) Hard, whitish orbital mass (arrowhead) surrounded by capsules was found via anterior orbitotomy. (B) Gross finding of mass after anterior orbitotomy. (C, D) Histologically, the peripheral portion of tumor was composed of thick capsule (asterisk) with fibrosis and scattered red blood cells (white arrows) (Hematoxylin and eosin stain [H&E] stain, ×40 [C] and ×200 [D]). (E, F) Capillary (black arrows) was formed inside the thrombus (H&E, ×40 [E] and ×200 [F]).
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