© 2017 Louisraj et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). International Medical Case Reports Journal 2017:10 255–259 International Medical Case Reports Journal Dovepress submit your manuscript | www.dovepress.com Dovepress 255 CASE REPORT open access to scientific and medical research Open Access Full Text Article http://dx.doi.org/10.2147/IMCRJ.S133284 Cavernous hemangioma of the orbit: an unusual acute presentation Sophia Louisraj 1 Thendral Ponnudurai 1 Dominic Rodriguez 2 Philip A Thomas 1 Christadoss Arul Nelson Jesudasan 1 1 Department of Orbit and Oculoplasty, Joseph Eye Hospital, 2 Department of Medicine, Kauvery Medical Centre, Tiruchirapalli, India Abstract: We report an unusual presentation of an orbital cavernous hemangioma in a 26-year-old female, who noted sudden redness and swelling of the left eye (LE) on waking up. At presentation, upper eyelid edema with periorbital ecchymosis and subconjunctival hemor- rhage were noted in the LE. Although there was transient symptomatic relief with topical medications, blurring of vision developed in the LE. When seen 10 days later, the patient’s LE showed axial proptosis. Magnetic resonance imaging revealed an intraconal soft tissue mass in the superomedial quadrant of the left orbit. Superior orbitotomy with mass excision was done; histopathological examination of the excised mass revealed a cavernous hemangioma. The patient had complete visual recovery following surgery. To our knowledge, an acute presentation of an orbital cavernous hemangioma with subconjunctival hemorrhage and periorbital ecchymosis has not previously been reported. Keywords: subconjunctival hemorrhage, ecchymosis, cavernous hemangioma Introduction Cavernous hemangiomas are the most common vascular lesions of the orbit in adults, being commonly seen in middle age, with a female predilection. 1 Over 80% of orbital cavernous hemangiomas are located within the intraconal compartment, most com- monly in the lateral aspect. 2 Progressive painless proptosis is the usual mode of pre- sentation, and acute presentations are rare. 3 We report an unusual acute presentation of an orbital cavernous hemangioma with subconjunctival hemorrhage (SCH) and periorbital ecchymosis. Case report Written informed consent has been provided by the patient to have the case details and any accompanying images published. A 26-year-old female presented with swelling and redness of the left eye (LE) that she noticed on waking up. She had not sustained antecedent trauma or undergone Valsalva maneuver and did not provide any other sig- nificant medical history such as bleeding diatheses or drug intake. On examination, the best corrected visual acuity in both eyes was 20/20, N5. The right eye examination was unremarkable. In the LE, there was SCH involving the bulbar temporal conjunctiva, along with upper eyelid edema and periorbital ecchymosis (Figure 1). The rest of the anterior segment, and the entire posterior segment, were normal. General and systemic examination findings were normal. Hematological investigations did not suggest any bleeding disorder. She was given symptomatic treatment and advised to review after a week. When she returned 10 days later, the swelling and redness were seen to Correspondence: Sophia Louisraj Institute of Ophthalmology, Joseph Eye Hospital, P.B.138, Tiruchirapalli, Tamilnadu, India Tel +91 43 1246 0622 Fax +91 43 1241 4969 Email dsophie1974@yahoo.com