warfarin and Exophthalmos

The authors describe the first report in the literature of delayed orbital hemorrhage that may be partly caused by supratherapeutic anticoagulation. A 52-year-old man with supratherapeutic international normalized ratio (INR) presented with acute proptosis, orbital pain and diplopia 9 months after the floor and medial orbital wall fracture repair using nylon foil implant. He was found to have hemorrhaged into the capsule surrounding the orbital implant. Three weeks later, the patient underwent implant removal after warfarin was discontinued for 5 days and INR was normalized. His symptoms resolved postoperatively. This case describes a unique risk factor of delayed orbital hemorrhage in patients with previous orbital fracture repair, and highlights that coagulopathy should be investigated in patients presenting with acute proptosis with a history of orbital fracture repair. The authors also provide a comprehensive and up-to-date literature review on previously reported cases with delayed hemorrhagic complications from alloplastic orbital implants.

Topics: Anticoagulants; Device Removal; Diplopia; Exophthalmos; Fracture Fixation; Humans; Male; Middle Aged; Nylons; Orbital Fractures; Retrobulbar Hemorrhage; Retrospective Studies; Tomography, X-Ray Computed; Warfarin

Spontaneous superior ophthalmic vein thrombosis (SOVT) is a rare entity. We describe three patients with spontaneous ophthalmic vein thrombosis, each with various risk factors.. A retrospective review of three patients with a diagnosis of superior ophthalmic vein thrombosis. Clinical characteristics, radiographic features, management techniques and outcomes are described.. All patients presented with unilateral painful proptosis. Two patients had intact light perception, whereas one patient presented with absent light perception. All patients had identifiable risk factors for thrombosis, which included sickle cell trait, hereditary hemorrhagic telangectasia and colon cancer with recurrent deep vein thrombosis. Anticoagulation was initiated in two patients. Resolution of proptosis was seen in all patients, with no recovery of vision in one patient.. Risk factors for spontaneous superior ophthalmic vein thrombosis are multifactorial. MRI and MRV confirm the diagnosis of SOVT. Despite urgent intervention devastating visual loss may occur.

Topics: Administration, Oral; Adult; Aged; Anticoagulants; Antihypertensive Agents; Colonic Neoplasms; Exophthalmos; Eye; Eye Pain; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Risk Factors; Sickle Cell Trait; Telangiectasia, Hereditary Hemorrhagic; Tomography, X-Ray Computed; Veins; Venous Thrombosis; Visual Acuity; Warfarin

We herein present the first reported case of severe proptosis caused by ocular and periocular hemorrhages in a continuous ambulatory peritoneal dilaysis patient without previous history of trauma. The bleeding tendency caused by uremia and the use of warfarin during uncontrolled high blood pressure were most likely responsible for her ocular and periocular hemorrhages. Appropriate control of blood pressure and adequate self-care education are important for the prevention and treatment of any bleeding complications in uremic patients receiving both maintenance anticoagulation therapy and peritoneal dialysis.

Topics: Adult; Exophthalmos; Eye; Female; Hemorrhage; Humans; Hypertension; Peritoneal Dialysis, Continuous Ambulatory; Uremia; Warfarin