Atypical chemosis: eyelid blepharocele

• Published in: BMJ case reports 2020-08, Vol.13 (8), p.e237826
• Main Authors: Narang, Shashank, Mehta, Aditi, Latawa, Archit, Dogra, Mohit
• Format: Article
• Language: English
• Subjects: Accidents, Traffic; Adolescent; Case reports; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - surgery; Cerebrospinal Fluid Leak - diagnosis; Cerebrospinal Fluid Leak - diagnostic imaging; Craniocerebral Trauma; Diagnosis, Differential; Emergency medical care; Eyelids; Eyes & eyesight; Fatal Outcome; Female; Fractures; Glasgow Coma Scale; Head injuries; Humans; Images In; Neuroimaging; Neurosurgery; ophthalmology; Pediatrics; radiology; Trauma
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-237826

A 13-year-old girl was brought in an unconscious state to the emergency department after having suffered from polytrauma in a road traffic accident. Her Glasgow Coma Scale was E1VTM4. She had undergone emergency craniotomy for drainage of intracerebral haemorrhage. An ophthalmology consult was requested for upper lid swelling with chemosis (figure 1A). On detailed evaluation, the patient was noted to have a transilluminant swelling of the left eye upper lid with forniceal conjunctival prolapse (figure 1B). The bulbar conjunctiva appeared healthy without any chemosis or subconjunctival haemorrhage. The eyeball was intact though the pupillary reactions were bilaterally sluggish. CT scans revealed a comminuted fracture of superolateral wall of the left orbit with swelling of left upper lid with fluid accumulation (figure 1C). A diagnosis of a post traumatic left upper eyelid blepharocele was established.