European Journal of Ophthalmology / Vol. 11 no. 1, 2001 / pp. 77-79 We describe a woman in whom bilateral orbital hemorrhage occurred during labor. She de- veloped sudden proptosis and complete loss of vision bilaterally. After a stillbirth, she un- derwent total hysterectomy because of atonic uterus and postpartum hemorrhage. The lo- cation of the hematomas was confirmed by magnetic resonance imaging. Clinical resolu- tion occurred in one month but both eyes remained blind. Fundoscopy revealed bilateral atrophy of the optic discs. (Eur J Ophthalmol 2001; 11: 77-9) KEY WORDS. Orbital hemorrhage, Labor, Blindness, Valsalva maneuver, Optic neuropathy Accepted: January 31, 2000 Bilateral orbital hemorrhage induced by labor INTRODUCTION Common causes of orbital hemorrhage include trauma, surgery, vascular anomalies, tumors, blood dyscrasias, and Valsalva maneuver. It has rarely been reported during labor (1-6). Anterior ischemic optic neuropathy is rare in the young, but it has been de- scribed in association with a number of conditions such as collogen vascular diseases, hypertension, mi- graine, and blood loss (7). We would like to present a 23-year-old woman who suffered bilateral orbital hemorrhage during labor and developed complete loss of vision bilaterally. Case report Four days before presentation at Hacettepe University Hospital, a 23-year-old woman had entered sponta- neous term labor. This was the patient’s first preg- nancy and preeclampsia had developed. After deliv- ery of the baby’s head the labour had slowed down, proptosis of both eyes had developed and the patient had lost her vision bilaterally. The infant was stillborn, and total hysterectomy was performed because of aton- ic uterus and postpartum hemorrhage, and a blood transfusion was given. She was referred to Hacettepe University Hospi- tal. On presentation, her visual acuity was no light perception OU. Motility was minimally restricted in all fields of gaze and exophthalmometry measure- ments were 21 mm at both eyes, showing symmet- rical bilateral proptosis. The pupils were both the same size and non-reactive to light. Slit-lamp bio- microscopy and tonometry results were unremark- able, but dilated fundus examination showed blur- ring of the optic disc margins bilaterally associat- ed with flame-shaped hemorrhages in the area of the optic disc on the left eye. Blood indexes and clotting parameters were normal. Magnetic resonance (MR) imaging demonstrated bi- lateral intraorbital, extraconally located hematomas. Dilated vascular structures were identified in the left orbit medial to the globe, suggesting a vascular mal- formation. The cavernous sinuses were unremarkable. The superior ophthalmic veins were symmetrical with normal caliber bilaterally. There was no de- struction of the bony structures of the orbit (Figs. 1, 2). MR imaging of the head gave results within normal limits. Management was limited to observation. The prop- tosis resolved gradually over the next four weeks with no residual deficits. Fundoscopy revealed clearance of the flame-shaped hemorrhages and bilateral atro- S. ORUÇ 1 , E. CUMHUR S ¸ ENER 2 , A. AKMAN 3 , A. S ¸ EFIK SANAÇ 2 1 Department of Ophthalmology, Adnan Menderes University Medical School, Aydin 2 Department of Ophthalmology, Hacettepe University Medical School, Ankara 3 Department of Ophthalmology, Bas ¸ kent University Medical School, Ankara - Turkey 1120-6721/077-03$01.50/0 © by Wichtig Editore, 2001 Case report SHORT COMMUNICATION