Recurrent retrobulbar hemorrhage owing to an orbital tumor: a primary orbital melanoma.
C. Additional imaging, including a computed tomography and positron emission tomography scan
The differential diagnosis of a retrobulbar hemorrhage includes orbital trauma; recent orbital, eyelid, lacrimal, or sinus surgery; orbital vascular anomalies; Valsalva-related hemorrhage in a patient with sinonasal carcinoma; and primary orbital tumor or metastasis.1,2 In this patient, there was no history of recent trauma or orbital or periorbital surgery. This presentation—recurrent retrobulbar hemorrhage associated with orbital mass effect over several weeks and restriction in upgaze—suggests an orbital tumor history but is not specific enough to eliminate an orbital vascular anomaly. At this stage, scheduling a follow-up without further investigation is not acceptable.