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Bilateral subperiosteal haemorrhage in a newborn
  1. Apjit Kaur1,
  2. Shaili Misra2
  1. 1Department of Ophthalmology, Chhatrapati Shahuji Maharaj University (CSMMU), (Erstwhile King George Medical College), Lucknow, Uttar Pradesh, India
  2. 2Department of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
  1. Correspondence to Dr Shaili Misra, Department of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh 271515, India; shaili020{at}yahoo.co.in

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A 13-day-old baby, born of a full term, uncomplicated, normal vaginal delivery at a primary healthcare centre presented with severe bilateral proptosis. At 12 h postpartum a presumed subconjunctival haemorrhage was seen on the temporal aspect of the right eye following which bilateral, rapid onset, painless proptosis developed.

At presentation in the department of ophthalmology CSMMU Lucknow, the child had bilateral, severe, axial, non-pulsatile, almost symmetrical proptosis, along with forniceal prolapse, conjunctival chemosis and exposure keratopathy. The ocular movements were restricted in all directions in both the eyes. There was no fundal view because of the severe exposure keratopathy (figure 1A). The systemic examination was normal and no evidence of bleeding diathesis or battering was found.

Figure 1

(A) A 13-day-old baby at the time of presentation with severe bilateral proptosis and exposure keratopathy. (B) The baby, 2 weeks after bilateral needle aspiration of subperiosteal haematomas and antibiotic treatment. Note the complete resolution of the proptosis with corneal opacity in the right eye and ensuing phthisis in the left. This figure is only reproduced in colour in the online version.

QUESTIONS

  1. What is the differential diagnosis of severe proptosis in a neonate?

  2. What are the most relevant investigations?

  3. What are the immediate management options?

  4. What are the long term issues in this case?

Answers (For Questions see 793) 1. What is the differential diagnosis of severe proptosis in a neonate?

Bilateral neonatal proptosis is rare. Several causes of proptosis in neonates have been discussed in literature. Orbital cysts are the most common with others being encephalocoele or meningomyelocoele, …

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