DISCUSSION
In the orbit; the hematopoietic medullary space is smaller, It is
therefore rare to find orbital bone infarcts in sickle cell patients
[1]. About thirty cases are described in the literature with an
average age of 14 years , half of which had an intraorbital hematoma
[2]. The singleness of our case in Madagascar would therefore allow
comparison with the literature and could provide additional data on the
diagnosis and management of intraorbital hematoma in children with
sickle cell disease. The bilateral form is rarely reported in the
literature. In a series conducted by Soko, the bilateral form represents
one third of reported cases [2]. This one makes our case a
particular form of intraorbital hematoma. Exophthalmos is a reflection
of the mass effect, it is the main mode of discovery of the
intra-orbital hematoma. The first functional manifestations are ocular
pain and localized edema. In the absence of urgent management, the
visual prognosis is at risk in case of optic nerve compression
[1,3]. Before the rapid onset of exophthalmos, especially since it
is bilateral; the differential diagnosis is vast. Among these, we can
cite orbital pseudotumor, orbital rhabdomyosarcoma, optic nerve glioma,
orbital extension of bilateral retinoblastoma, bilateral orbital
cellulitis. In all these possibilities, Imaging studies are of paramount
importance in characterizing the nature of the compressive mass. In our
case, the hematic density was spontaneously hyperdense on the CT scan,
suggesting the diagnosis of a bilateral intra-orbital hematoma. The
Magnetic resonance imaging, which would determine the hematic nature of
the collection [4] not being accessible, the CT scan therefore
remains an examination that retains its place although it is relatively
non-specific. However, the absence of sinus pathology and the location
of the collection on the lateral wall of the orbit are the arguments
against an abscess [2] especially that the clinical and biological
examination are sterile. Medical treatment seems to be sufficient in
most cases, including treatment of the crisis and the use by some teams
of corticosteroids to be used with caution in the context of sickle cell
disease [1,2]. Surgery is reserved for cases of persistent
compression of the optic nerve [2]. In our case, the treatment is
purely medical, making the exophthalmos disappear after one month with a
recovery of the visual acuity ad integrum.