CASE REPORT
A 15 year old boy, known to have homozygous sickle cell disease, came for a consultation with headache and bilateral eye pain which had been evolving for two weeks in a context of apyrexia. In his background, there was no notion of craniofacial traumatism or recent surgery. On ophthalmological examination; bilateral diplopia, palpebral edema and bilateral exophthalmos painful, non-pulsatile and non-reducible were noted. The measured visual acuity was altered to 5/10 for the right eye and 7/10 for the left eye. The fundus examination was very limited and did not show any particularities. Other examinations, especially neurological, were unremarkable. The formal blood count showed a discrete anemia with a hemoglobin level of 9.3 g/dl; the neutrophilic polynuclear and platelet counts were within the normal range. The C-reactive protein level was discretely elevated at 7 mg/L. The hemostasis assessment was also normal. Oculo-cerebral CT scan with parenchymal window showed a bilateral intraorbital structure, spontaneously hyperdense, of hematic density, in intra and extra-conical situations, pushing forward and down the two ocular globes (figure 1). In the bone window, it showed a bilateral exophthalmos of grade 3 without abnormal bone structure (Figure 2). Ocular B-mode ultrasound was performed but was very limited because of the narrowing of the acoustic window due to the exophthalmos. In front of the anamnestic, clinical and scannographic context, the diagnosis of a spontaneous bilateral intraorbital hematoma in a sickle cell patient was evoked. The patient was put on oral corticosteroids for five days. And in front of the ocular pain, a treatment containing analgesic was instituted. The evolution was favorable after one week, marked by the regression of the exophthalmos and a progressive recuperation of visual acuity and oculomotricity. The Oculocerebral CT scan at one week showed regression of the intraorbital hematoma (Figure 3) . The recuperation of visual acuity and oculomotricity ad integrum was achieved after one month with total disappearance of the exophthalmos (Figure 4).The patient was then readmitted to the sickle cell management center.