Bilateral proptosis: an unusual primary presentation of scurvy—a case report

Background Scurvy is a nutritional vitamin C deficiency disease which shows classical signs on radiographs most commonly along long bones with subperiosteal hemorrhage being a classical finding. Primary presentation of scurvy with orbital hemorrhage presenting as proptosis is however uncommon. Case presentation We report an unusual primary presentation of scurvy in a 4-year-old boy with West syndrome and global developmental delay who presented to the emergency with complaints of bilateral proptosis and eyelid swelling (right > left) which on examination revealed bluish discolouration of bilateral eyelids. On further multimodality imaging investigation, orbital subperiosteal hemorrhages were identified as the cause, along with classical radiographic features of scurvy in bilateral lower limb long bones. The diagnosis was further bolstered by rapid resolution of periorbital ecchymosis after initiating oral vitamin C supplementation. Conclusion To the best of our knowledge, primary presentation of scurvy in the form of bilateral proptosis due to orbital hemorrhages although uncommon can still be a manifestation of scurvy in addition to the more routinely detected subperiosteal hemorrhages along long bones. The significance of establishing the aetiology in such cases of orbital hemorrhage cannot be overemphasised, in view of drastic clinical recovery after starting vitamin C therapy.

Spontaneous unilateral exophthalmos after a vaginal delivery

Introduction: Spontaneous orbital exophthalmos is an extremely rare incident during a vaginal delivery. In most cases, it is associated with venous malformations and presents spontaneous resolution. Case description: We report a case of orbital hematoma after vaginal delivery due to a superior ophthalmic vein rupture. The patient presented proptosis of the right eye and diplopia immediately after the delivery and was diagnosed with unilateral orbital hematoma. The patient was given conservative treatment with complete resolution of clinical symptoms 4 weeks after the delivery. Conclusion: Increased abdominal pressure during a vaginal delivery may lead to a spontaneous orbital hemorrhage.