An Atypical Presentation of Disseminated Intravascular Coagulation Following Ocular Interventions for Proliferative Diabetic Retinopathy: Mimicking Retrobulbar Hemorrhage

A 42-year-old man with poorly controlled diabetes mellitus, hypertension, chronic kidney disease, and a diabetic foot received treatment with panretinal laser photocoagulation in his right eye and intravitreal injection of Bevacizumab in both eyes to manage proliferative diabetic retinopathy accompanied by diabetic macular edema in the right eye and complicated by vitreous hemorrhage in the left eye. He then presented on the same day with right eye pain, eyelid swelling, ecchymosis, and subconjunctival hemorrhage. Additionally, he showed right-sided signs suggestive of facial palsy. Laboratory tests revealed a significantly low platelet count. Orbital and brain imaging ruled out retrobulbar hemorrhage and ischemic insults. A referral was made to a tertiary hospital for further evaluation and treatment of suspected disseminated intravascular coagulation (DIC) by a multidisciplinary team. To the best of our knowledge, the development of DIC after ocular procedures has not been previously reported. We recommend careful management of patients with poorly controlled diabetes and kidney disease to prevent further systemic complications.