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Four-year-old girl with acute proptosis right eye

B-Scan ultrasound image with A scan overlay of the right orbit

These show papilldema in the right eye.

This 4-year-old girl developed a conjunctival hemorrhage in the right eye ten days ago followed almost immediately by painless proptosis in the right eye as shown above. The girl is otherwise in good health. Vision is good in the left eye, the media are clear and the refraction is plano. She does not cooperate with vision testing and objects to covering the left eye. Retinoscopy in the right eye is + 1.00. The eye does not feel "hot”.

1.	What is the most likely diagnosis?
	c -- lymphangioma with hemorrhage Lymphangioma with hemorrhage is the most likely diagnosis here. Each of the other diagnoses should be considered but the sudden onset and the extent of the proptosis suggest that hemorrhage in a lymphangioma is the most likely cause.
2.	What diagnostic test would you do to best arrive at a diagnosis?
	d -- imaging of the orbit, preferably with MRI The ultrasound evaluation shown above does confirm the diagnosis.
3.	How would you treat this case?
	d -- observe carefully, watching for compressive optic neuropathy and treating with steroids if needed but mainly watch and wait for resolution

Reference:

“Current Ocular Therapy” - available on this web site free going to E-Learning and logging in with user name and password available to all visitors from developing countries.