Case report of unilateral retrobulbar hematoma associated with von Willebrand disease in a Doberman Pinscher dog

Abstract

Abstract A 5‐year‐old Doberman Pinscher dog was presented with sudden onset left‐sided periocular bleeding following third eyelid gland replacement surgery. Left‐sided exophthalmos and 360‐degrees subconjunctival hemorrhage were present. The ophthalmic examination revealed blindness with absent direct and consensual pupillary light reflexes. A superficial exposure ulcerative keratitis due to exophthalmos was also present. Computed tomography (CT) revealed a large left‐sided retrobulbar mass lesion surrounding the optic nerve, compatible with a retrobulbar hematoma. Due to absence of orbital fractures and no history of trauma, a coagulopathy was strongly suspected. The buccal mucosal bleeding time (BMBT) was prolonged (>4 minutes) consistent with a primary hemostatic defect in the absence of thrombocytopenia. Von Willebrand factor antigens levels were decreased (24%‐ Normal Range: 50%‐150%). Surgical drainage of the retrobulbar hematoma was performed uneventfully thirty minutes after subcutaneous injection of desmopressine acetate, Minirin® (1 µg/kg, SC). Von Willebrand disease type I gene mutation was confirmed by PCR amplification of the DNA encoding von Willebrand factor. This case report demonstrates that hemostatic disorders, including von Willebrand Disease (vWD), are a risk factor for orbital bleeding following surgical trauma. Retrobulbar hematoma should be considered as a differential diagnosis in any dog with exophthalmos.

Keywords

• dog
• exophthalmos
• ophthalmology
• orbital disease
• primary hemostatic disorder
• thrombocytopathia