Spontaneous Orbital Hematoma in a 2-day Old Neonate: A Case Report.

BACKGROUND: Intra-orbital hematoma is an eye disease that is usually attributed to trauma, neoplasm, acute sinusitis or vascular malformations. However, spontaneous hematoma is a rare condition and can be an early manifestation of hematological disorders. CASE REPORT: This is a case report on a 2-days old male neonate presented with proptosis of the right eye since the second day of birth. The pregnancy was term and the delivery was at health center by spontaneous vaginal delivery in which no instruments were used. He had no history of trauma and no bleeding from other sites. On physical examination, he had axial proptosis of the right eye of 26mm, injected conjunctiva and corneal ulcer with infiltrates. On complete blood count, white blood cell was 23.53×103, red blood cells= 3.96×106, platelets = 279×103/µL, hemoglobin = 13.5g/dl, hematocrit = 38.7%. Coagulation profile test showed; prothrombin time = 5.1 with reference range of (10-14 seconds); partial thromboplastin time = 24.9 reference range of (22-27seconds) and international normalization ratio = 0.4 with reference range (0.8- 1.1). Ultrasound showed hematoma collection, and clotted blood was surgically drained with no other intra-operative finding. After the surgery, he took systemic and topical antibiotics, and progressively, the proptosis, conjunctival injection and corneal ulcer improved. CONCLUSION: In our case, we were not able to know the exact cause for the orbital hematoma. Although it is not common, we have to consider the possibility of spontaneous hematoma as a cause of sudden proptosis in neonates.

Bilateral Keratomalacia Secondary to Diet Induced Vitamin A Deficiency in an Ethiopian Young woman: A Case Report.

BACKGROUND: Diet induced vitamin A deficiency is less commonly seen in otherwise healthy adults, due to large store of vitamin A in the body. Night blindness is the commonest manifestation of vitamin A deficiency in adults, whereas Keratomalacia is a rare manifestation. CASE REPORT: A 27 years old Ethiopian woman came to Jimma University Department of Ohthalmology with a compliant of protrusion of the globe content of both eyes within a week, after having redness and fear of light of both eyes for 2 months. She was a mother of twins and had low socioeconomic status. On general examination, she was cachectic with enlarged parotid glands. On ocular examination, she was bilaterally blind and had dry ocular surface. There was bilaterally melted cornea with prolapsed uveal tissue. After several investigations she was diagnosed as bilateral Keratomalacia (stage X3B) secondary to diet induced vitamin A deficiency. She was supplemented with vitamin A and other nutritional supplementation. Topical lubricating drops and ointments were administered. Finally, conjunctival flap was done to preserve the globe. CONCLUSION: Although it is rare, treating physicians should be aware of the occurrence of Keratomalacia in adults which is potentially blinding. Early recognition and treatment of vitamin A deficiency at the stage of night blindness is essential in reducing blindness caused by Keratomalacia.