{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T14:18:31Z","timestamp":1785507511975,"version":"3.56.0"},"reference-count":22,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Periorbital ecchymosis, or \u201craccoon eyes,\u201d often indicates a basilar skull fracture. When trauma is absent, clinicians should consider other causes, such as Valsalva maneuvers, bleeding disorders, or systemic inflammation. Spontaneous orbital hemorrhage is rare, and its appearance as a mass causing a secondary orbital roof blow-out fracture is even more unusual. This report presents a unique case of primary spontaneous orbital hemorrhage (PSOH) leading to a secondary orbital blow-out fracture; Case Presentation: A 60-year-old man with a history of ulcerative colitis (UC) presented with acute-onset, non-traumatic, and bilateral periorbital bruising, swelling, and right-sided vision loss. Computed tomography (CT) showed a mass lesion in the right orbit with an associated orbital roof fracture. Following excision, histological examination showed extravasated blood. Additional laboratory work-up helped rule out possible hematologic and inflammatory etiologies, confirming a diagnosis of PSOH with a secondary orbital roof fracture; Conclusions: This case demonstrates that PSOH can generate sufficient intra-orbital pressure (IOP) to cause a secondary blow-out fracture, a phenomenon not previously reported in the literature. Furthermore, it emphasizes the need for a systematic diagnostic approach to exclude potential systemic etiologies in patients presenting with spontaneous periorbital ecchymosis. In addition, this case highlights the critical importance of rapid decompression in managing orbital compartment syndrome (OCS) to prevent permanent visual loss.<\/jats:p>","DOI":"10.3390\/reports9030247","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T13:23:20Z","timestamp":1785504200000},"page":"247","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Primary Spontaneous Orbital Hemorrhage with Secondary Orbital Roof Blow-Out Fracture: A Case Report"],"prefix":"10.3390","volume":"9","author":[{"given":"Nagi A.","family":"Massoud","sequence":"first","affiliation":[{"name":"Dr. Sulaiman Al-Habib Medical Group, Department of Surgery, Buraidah 51431, Qassim, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Mahmoud","family":"Bakr","sequence":"additional","affiliation":[{"name":"Dr. Sulaiman Al-Habib Medical Group, Department of Medicine, Buraidah 51431, Qassim, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8102-3770","authenticated-orcid":false,"given":"Abdulrahman H.","family":"Alashkar","sequence":"additional","affiliation":[{"name":"Dr. Sulaiman Al-Habib Medical Group, Department of Surgery, Buraidah 51431, Qassim, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2330-8038","authenticated-orcid":false,"given":"Mohamed","family":"Ghazala","sequence":"additional","affiliation":[{"name":"Sulaiman AlRajhi University, College of Medicine, Department of Clinical Sciences, AlBukayriyah 51941, Qassim, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/S0020-1383(01)00144-9","article-title":"\u2018Raccoon eyes\u2019 (periorbital haematoma) as a sign of skull base fracture","volume":"32","author":"Herbella","year":"2001","journal-title":"Injury"},{"key":"ref_2","first-page":"504","article-title":"Secondary systemic amyloidosis in inflammatory bowel disease: A nationwide analysis","volume":"30","author":"Sharma","year":"2017","journal-title":"Ann. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/j.jdcr.2019.05.018","article-title":"An unusual cause of bilateral orbital swelling: Immunoglobulin G4-related orbital disease arising in a patient with ulcerative colitis","volume":"5","author":"Queen","year":"2019","journal-title":"JAAD Case Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1080\/01676830.2024.2355641","article-title":"Valsalva-associated orbital compartment syndrome in the setting of frontoethmoidal mucocele and orbital cellulitis","volume":"44","author":"Lewis","year":"2025","journal-title":"Orbit"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"OCT189","DOI":"10.1167\/iovs.15-18449","article-title":"Effects of Valsalva Maneuver on Anterior Chamber Parameters and Choroidal Thickness in Healthy Chinese: An AS-OCT and SS-OCT Study","volume":"57","author":"Li","year":"2016","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/IOP.0000000000002480","article-title":"Structural Limits of Orbital Compliance and Treatment Options for Pathologic Orbital Pressure","volume":"40","author":"Chelnis","year":"2024","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e122","DOI":"10.1097\/IOP.0000000000002172","article-title":"Recurrent Retrobulbar Hemorrhage Associated With CPAP Use After Orbital Fracture Repair","volume":"38","author":"Ryu","year":"2022","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"10","DOI":"10.46989\/001c.155180","article-title":"Factor XIII Deficiency: A Review of Biology, Testing, and Treatment","volume":"8","author":"Jacobs","year":"2026","journal-title":"Clin. Hematol. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.radcr.2015.12.006","article-title":"Nontraumatic orbital floor fracture after nose blowing","volume":"11","author":"Sandhu","year":"2016","journal-title":"Radiol. Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1097\/IOP.0000000000001627","article-title":"Acute Spontaneous Rupture of the Superior Ophthalmic Vein","volume":"36","author":"Vahdani","year":"2020","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"198","DOI":"10.13181\/mji.cr.247428","article-title":"Systemic amyloidosis following inflammatory bowel disease, follicular lymphoma, and diffuse large B-cell lymphoma: A case report","volume":"33","author":"Sukrisman","year":"2024","journal-title":"Med. J. Indones."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.37871\/jbres2183","article-title":"Clinical Features of AL Amyloidosis Presenting with Raccoon Eyes: A Case Report and Literature Review","volume":"6","author":"Yijie","year":"2025","journal-title":"J. Biomed. Res. Environ. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2393","DOI":"10.2169\/internalmedicine.8927-21","article-title":"Raccoon Eye Sign in Amyloid Light-chain Amyloidosis","volume":"61","author":"Mizuno","year":"2022","journal-title":"Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Mei, S., Zhao, Y., Li, L., Mei, C., and Dai, B. (2020). A 64-year-old woman with raccoon eyes following kidney biopsy: A case report. BMC Nephrol., 21.","DOI":"10.1186\/s12882-020-01770-4"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1097\/CM9.0000000000001891","article-title":"Update on classification, diagnosis, and management of immunoglobulin G4-related disease","volume":"135","author":"Chen","year":"2022","journal-title":"Chin. Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e6205","DOI":"10.1097\/MD.0000000000006205","article-title":"Ophthalmic manifestations in IgG4-related disease","volume":"96","author":"Ebbo","year":"2017","journal-title":"Medicine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/APO.0000000000000552","article-title":"Radiological Determinants of Complicated Immunoglobulin G4-Related Ophthalmic Disease: A Territory-Wide Cohort Study","volume":"11","author":"Lai","year":"2022","journal-title":"Asia-Pac. J. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.survophthal.2013.07.002","article-title":"Nontraumatic orbital hemorrhage","volume":"59","author":"McNab","year":"2014","journal-title":"Surv. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.ijom.2004.05.001","article-title":"Diagnosis and treatment of retrobulbar haematomas following blunt orbital trauma: A description of eight cases","volume":"34","author":"Gerbino","year":"2005","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0161-6420(80)35283-4","article-title":"Central retinal artery occlusion and retinal tolerance time","volume":"87","author":"Hayreh","year":"1980","journal-title":"Ophthalmology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"104445","DOI":"10.1016\/j.jcms.2026.104445","article-title":"Diagnosis and management of orbital compartment syndrome caused by retrobulbar hematoma following orbital fractures","volume":"54","author":"Bourquard","year":"2026","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.jemermed.2018.12.019","article-title":"Ocular Compartment Syndrome and Lateral Canthotomy Procedure","volume":"56","author":"Amer","year":"2019","journal-title":"J. Emerg. Med."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/247\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T13:47:44Z","timestamp":1785505664000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/247"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":22,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["reports9030247"],"URL":"https:\/\/doi.org\/10.3390\/reports9030247","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]}}}