眼窩上壁骨折に伴って発症した眼窩骨膜下血腫の１例

抄録

　　A 76-year-old man visited our emergency room following a fall that also bruised his right eye. He had been taking antiplatelet medication. He exhibited decreased visual acuity, increased intraocular pressure, and restricted movement of his right eye. Simple computed tomography (CT) demonstrated no obvious fracture or pneumocephalus. However, a convex lens-shaped hyper-absorption area was observed along the right supraorbital wall. These findings led us to a diagnosis of orbital subperiosteal hematoma. An emergency incision was made in the right eyebrow region three hours after injury under local anesthesia to drain the hematoma. A Penrose drain was inserted to preserve his vision and the patient was admitted to the hospital. After 36 hours, hemostasis was performed under general anesthesia due to hypotension caused by excessive bleeding. Intraoperative findings included spinal fluid leak, a linear fracture line on the supraorbital wall, and bleeding from the same site, which was cauterized. The patient recovered uneventfully and was discharged on the 3rd day of illness. Draining a hematoma under local anesthesia may help preserve vision. However, if the bleeding point cannot be identified, the possibility of hemostasis under general anesthesia, including frontal craniotomy, should be considered.