A marked exophthalmos and corneal ulceration caused by delayed massive expansion of a subgaleal hematoma

A 12-year-old girl had the hair on the right side of her head pulled during a quarrel, after which a subgaleal hematoma (SGH) developed over her right cranium. The subcutaneous swelling progressed to the forehead, and a marked exophthalmos then developed on the left side. The bilateral, liquefied SGH was removed surgically, and two drainage catheters connected to a vacuum-drain pump were introduced. After the surgery, the SGH disappeared. The liquefied hematoma was aspirated by puncturing the superolateral portion of the left orbit. Thereafter, the left exophthalmos rapidly disappeared. A chemical analysis of the SGH revealed that it contained extremely low levels of fibrinogen and platelets, and high levels of fibrinogen and fibrin degradation products, suggesting that secondary fibrinolysis had occurred in the subgaleal space.

Subgaleal hematomas are usually treated conservatively. However, closed observation is necessary, and if increased expansion is seen, aspiration with a closed drainage system should be considered.