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.