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Non-traumatic extraocular muscle haemorrhage associated with anticoagulation use
  1. Dona Al Rayess1,
  2. Nicolette Sirju1,
  3. Rachel Smith2 and
  4. Elizabeth Alexandra Davies1
  1. 1Medicine, Swansea Bay University Health Board, Port Talbot, UK
  2. 2Radiology, Swansea Bay University Health Board, Port Talbot, UK
  1. Correspondence to Dr Elizabeth Alexandra Davies; ElizabethAlexandra.Davies{at}


We present a case of a unilateral extraocular muscle haematoma in an adult female patient who was compliant with life-long oral anticoagulation for recurrent deep vein thrombosis. The patient presented with symptoms of sudden-onset left-sided headache radiating to the temporal region, which started 2 days prior. No obvious triggering factors were identified. Cranial and ocular examinations were within normal limits. Imaging revealed a haemorrhage related to the lateral rectus muscle of the left eye. Conservative management was employed with abstinence from anticoagulation for 2 weeks and a weaning regime of oral steroids. Under the clinical review of ophthalmology and interval radiological monitoring, symptoms were reduced with reduction of haemorrhage size. Anticoagulation was reinstated after 2 weeks. To our knowledge, this is the first case of a non-traumatic extraocular muscle haematoma to be reported in a patient on anticoagulation.

  • Haematology (drugs and medicines)
  • Musculoskeletal and joint disorders
  • Ophthalmology
  • Unwanted effects / adverse reactions
  • Radiology

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  • Contributors DAR and NS have contributed as first authors. Both worked on the ward where the patient first presented and equally contributed to writing and finalising the case. RS has contributed by reporting the patient's scans for the purpose of writing the case. She has also contributed to the revision of the case and final approval before submission. EAD took the responsibility of diagnosing and managing the patient. She has also contributed to the revision of the case and final approval before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.