BMJ Case Reports 2017; doi:10.1136/bcr-2017-223028
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Spontaneous retrobulbar haemorrhage in idiopathic thrombocytopenic purpura

  1. Carlos Marques-Neves1,2
  1. 1Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal
  2. 2Department of CECV, Universidade de Lisboa Associacao para a Investigacao e Desenvolvimento da Faculdade de Medicina, Lisboa, Portugal
  1. Correspondence to Professor Carlos Marques-Neves,{at}
  • Accepted 5 December 2017
  • Published 13 December 2017


An 81-year-old male patient presented to the emergency department with complaints of intense and active subconjunctival haemorrhage, eyelid ecchymosis and proptosis of the right eye (optic disc, OD) with 1 hour of evolution (figure 1). The patient indicated no related pain, headache or recent head trauma. He referred to have reduced vision of the same eye 20 years prior to this event, which he could not explain. His medical history presented an idiopathic thrombocytopenic purpura (ITP), which had been treated with azathioprine for the past 4 years. Visual acuity (VA) of OD was 20/200 (same as previously), with no ocular motility restrictions or afferent pupillary defect. The intraocular pressure (IOP) OD was 22 mm Hg. Fundus examination revealed an OD of normal appearance, with no signs of posterior compression. A non-contrast CT of the brain and orbit revealed thickening and densification of the periorbital soft tissues, relative proptosis of OD and intraconal retro-orbital …

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