The Role of Early Office-Based Needle Aspiration in the Management of Subperiosteal Hematoma

Purpose: Subperiosteal hematoma of the orbit is a rare complication that may occur in different situations. The most common cause is blunt trauma to the head region. There is no uniform approach in the literature in the management of subperiosteal hematoma and herein, we introduce an office-based method for aspiration of the subperiosteal hematoma in cases without signs of visual compromise. Methods: Four boys (12-15years) were referred to our clinic with a provisional diagnosis of subperiosteal hematoma after blunt trauma. Best corrected visual acuity of both eyes of both the patients was 20/20. The RAPD was negative. Although in our patients, no one had compressive optic neuropathy, they underwent hematoma aspiration. All procedures were performed in an office-based setting without local anesthesia or sedation. The child patient was placed on a procedure bed in a supine position. We asked him to gently close his eyes during the procedure. After the establishment of IV-line and prep and drape, a green, 21-gauge catheter under the superior rim was advanced. The index finger of the other eye pushed the globe downward for protection of the globe. After reaching the collection of hematoma, it was evacuated. Results: Approximately 6-7 cc of dark blood was evacuated. All the patients tolerated the procedure comfortably and the procedure was uneventful. The range of extraocular movements became normal immediately after the procedure. No case of recurrence or infection was observed in these series of patients. Conclusion: When there is no indication for orbitotomy, office-based needle aspiration in comparison to follow-up or administration of the steroid, is a viable approach because of its feasibility, an office-based treatment that obviates the need for general anesthesia and yield immediate recovery. In this study, all the patients tolerated the in-office procedure with light sedation. No patient required additional incisional surgery.