Orbital venous anomaly presenting with orbital hemorrhage.

PURPOSE: To report on the characteristics of patients with orbital venous anomaly presenting with acute orbital hemorrhage.
METHODS: We retrospectively reviewed the clinical and radiologic findings of a case series of eight orbital venous anomaly patients who presented with orbital hemorrhage. Charts of patients diagnosed as having orbital venous anomaly who initially presented with orbital hemorrhage were selected.
RESULTS: The eight patients with orbital venous anomaly (one man and seven women) ranged in age from 7 to 66 years (median, 22 years). The average duration of symptoms was 7 days (range, 1-30 days). All eight patients were totally asymptomatic prior to their acute presentations. Orbital computed tomography (CT) scans showed a well-demarcated ovoid mass in all eight patients. Five patients were referred with a suspicion of orbital tumor, and one underwent a lateral orbitotomy for a biopsy. In six patients, the presence of an orbital hemorrhage was identified by typical findings on orbital magnetic resonance imaging (MRI). After resolution of the hemorrhage, all patients evidenced a distensible orbital venous anomaly in an imaging study.
CONCLUSION: An orbital venous anomaly presenting with sudden orbital hemorrhage can be mistaken for other orbital tumors. In patients with acute orbital process, orbital MRI for detecting hemorrhage and a follow-up CT scan after resolution of the hemorrhage are needed to prevent unnecessary surgical intervention.