[Orbital hemorrhage as a sequela of heparin-induced thrombocytopenia].

BACKGROUND

Spontaneous orbital hemorrhage is a rare but sight threatening incident. Several causative factors are known. Infrequently, hemorrhagic ocular complications can be associated with heparin therapy. The mechanism can involve a immunologically caused thrombocytpenia. In every hemorrhagic ocular complication which occurs in patients treated with heparin Heparin-induced thrombocytopenia (HIT) must be taken into consideration.

PATIENT

A 76-year-old woman who underwent hip surgery three weeks prior to a spontaneous orbital hemorrhage had been treated with subcutaneous heparin. CT scan of the right orbit showed peribulbar hemorrhage with the main focus retro-lateral of the bulbus. Retrobulbar expansion of the hemorrhage was only slight with no compression of the optic nerve. There was no sign of tumor or anomaly of blood vessels. Blood cell count revealed a marked thrombocytopenia with 8000/microliter. After discontinuation of heparin therapy, thrombocytes' cell counts rised rapidly with 114,000/microliter after three days. Parallel to the normalization of the thrombocytes' cell counts the clinical symptoms disappeared quickly.

CONCLUSIONS

Heparin-induced thrombocytopenia as a cause for spontaneous orbital hemorrhage has never been reported before. For differential diagnosis in patients with hemorrhagic ocular complications, HIT must taken into account. The most important measure is counting thrombocytes. In thrombocytopenia, heparin therapy must be discontinued before hemorrhagic or thromboembolic complications occur.