Spontaneous Resolution of a Symptomatic Post-traumatic Orbital Subperiosteal Hematoma

Purpose: A 12-year-old boy with a five-day history of blunt trauma to the right orbit was referred to our pediatric ophthalmology clinic for evaluation of diplopia and proptosis.Case summary: Upon examination, uncorrected visual acuity was 20/20 in both eyes, intraocular pressures were 19 mmHg and 16 mmHg in the right and left eye, respectively, and Hertel exophthalmometry revealed 2 mm of right eye proptosis. Extraocular motility testing demonstrated 16 prism diopters (PD) of right exotropia and 2 PD of right hypotropia in primary position, with restricted upgaze in the right eye. Pupillary reflexes, color vision, slit-lamp biomicroscopy, and fundus examination were normal. Orbital computed tomography (CT) showed a subperiosteal hematoma compressing the right superior rectus muscle. The patient was managed conservatively, with resolution of upgaze limitation within six months. Follow-up CT at nine months demonstrated complete hematoma resolution without residual orbital mass.Conclusions: Spontaneous resolution of post-traumatic orbital subperiosteal hematoma is rare but possible; in the absence of compressive optic neuropathy, careful observation with regular follow-up should be considered.