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.
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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.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Alexis Mathieu, MD, CHU Bordeaux, Service d’Ophtalmologie, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France (firstname.lastname@example.org).
Published Online: August 11, 2022. doi:10.1001/jamaophthalmol.2022.2875
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank Romain Perbet, MD, for the pathological analysis of this difficult case. There was no financial compensation for this contribution.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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