A patient in their 70s presented to the emergency department (ED) with a unilateral painless right proptosis, first noticed 3 days prior. There was no contributory medical history, recent trauma, or surgery. Visual acuity (VA) was 20/32 OD and 20/20 OS. Anterior-segment and fundus examination results were normal. Magnetic resonance imaging (MRI) of the orbits revealed a right retro-orbital hemorrhage. No etiology could be identified on the image. Systemic corticosteroid therapy (methylprednisolone, 1 mg/kg per day) was prescribed for 48 hours. The proptosis decreased, and the patient was discharged.
After 6 months, complete ophthalmologic examination was performed again; VA was 20/20 OU, and there was no remaining proptosis. Two weeks later, the patient presented to the ED for another episode of acute, painless, right proptosis, and the VA had decreased to 20/40 OD. MRI showed a right retrobulbar hemorrhage. Systemic corticosteroid therapy was again prescribed for 48 hours with rapid resolution of the visual impairment but incomplete resolution of the proptosis.