title: Non-traumatic orbital haemorrhage.
abstract: OBJECTIVE
  To establish the incidence of underlying orbital vascular anomalies, the presence of systemic associations and predisposing factors, the natural history and appropriate management of patients with non-traumatic orbital haemorrhage presenting in an orbital clinic.
  
  
  METHODS
  The records of 115 patients with a diagnosis of non-traumatic orbital haemorrhage were reviewed with regard to clinical findings, investigations, management and outcome.
  
  
  RESULTS
  Associated orbital vascular malformations were present in 104 patients (90%). Thirteen (11%) had additional or other predisposing factors (childbirth, prolonged headstands, hypertension or coagulopathies). Six patients (5%) had no predisposing factor. Acute onset painful proptosis, associated with lid swelling or a mass, was the most common presentation. Visual acuity was reduced in 37 patients (32%) at presentation. Excluding eight patients (7%) who underwent surgery for optic nerve compression, spontaneous resolution of the haemorrhage was complete in 62%, partial in 27%, while 4% had no resolution. Final visual acuity was reduced in 23 patients (20%).
  
  
  CONCLUSIONS
  The majority of bleeds are associated with some form of orbital vascular anomaly. Where no such anomaly can be demonstrated a search for an underlying systemic cause should be performed. Haemorrhages in the young were usually localized whereas those in older patients were diffuse. Orbital imaging, with a combination of computed tomography and magnetic resonance imaging, was helpful in the assessment of these lesions. Most bleeds are venous and self-limiting. Surgical intervention was rarely necessary and should be confined to those with optic nerve compromise or a localized lesion which persists.
authors.affiliation: Orbital Clinic, Moorfields Eye Hospital, London, UK. tjs@gil.com.au
authors.forename: T J
authors.initials: TJ
authors.lastname: Sullivan
authors.forename: J E
authors.initials: JE
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001165:Arteriovenous Malformations / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D005094:Exophthalmos / Q000175:diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000098:blood supply; D019315:Retrobulbar Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D006113:United Kingdom / Q000453:epidemiology; D014680:Veins / Q000002:abnormalities; D014792:Visual Acuity