A 34-year-old woman, 18 weeks pregnant, came to the emergency room because during an episode of hyperemesis gravidarum with projective vomiting suddenly presented with right supraorbital swelling and right eye proptosis.
The patient had no personal history of interest, did not take any regular medication or had suffered any previous trauma.
Apsy revealed myalgia, ecchymosis with right eye hypophthalmos, right mydriasis of 7 mm with decreased pupil reactivity, limitation of supraduction and supradesversion with diplopia
Examination of the eye fundus was normal with intraocular pressure of 24 mmHg.
No edema or vascular anomalies were observed in the conjunctiva.
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Because the patient was pregnant, an urgent orbital magnetic resonance imaging (MRI) was requested. The findings were consistent with the diagnosis of right extraconal intraorbital hematoma.
A blood analysis based on blood count, biochemistry and routine coagulation did not show any alterations that could have precipitated the condition.
Due to the clinical repercussion and the increasingly evident alterations in the patient's vision, it was decided to urgently intervene surgically to evacuate the hematoma and compress the orbit under general anesthesia.
A right superior blepharoplasty approach was performed, dissecting the orbicular muscle of the eye and periosteum, until reaching the supero-external orbital ridge.
By placing the periosteum at the level of the orbital surface of the frontal bone, clots and blood were released under pressure from the extraconal hematoma.
After evacuation of the hematoma, no bleeding points were observed in any vessel in the region.
A Penrose-type thin drainage was placed and treatment for hyperemesis gravidarum was established with pyridoxine 10 mg/8 h iv+thiamine 100 mg/24 h iv +/8hclopr.
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The patient was asymptomatic and without sequelae after surgery. The patient had mydriasis and visual alterations in the first postoperative hours. Drainage was removed 48 hours after surgery.
