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Purpose Nontraumatic subperiosteal orbital hemorrhage (NTSOH) has been reported rarely in association with sudden elevation of cranial venous pressure, generalized diseases with bleeding diatheses, and paranasal sinusitis. To define more clearly the clinical and imaging characteristics of NTSOH, we evaluated nine cases seen by the authors and reviewed previous case reports. Design Retrospective, noncomparative case series. Participants Nine patients (10 eyes) with NTSOH. Intervention All patients underwent computed tomography scans of the orbits. Patients with typical clinical and imaging features and normal visual function were observed. Those with an uncertain diagnosis or visual compromise underwent surgical drainage of the hematoma. Main outcome measures Resolution of proptosis, diplopia, lid swelling, and ptosis. Results Nine patients ranging from birth to 73 years of age were identified. All were females. The lesions were located superiorly in eight patients (one patient had bilateral lesions) and medially in one patient. Most were associated with sudden elevation in venous pressure (vomiting, strangulation, straining), and most required no surgical intervention. The bilateral case occurred in the setting of disseminated intravascular coagulation and was the only case associated with visual loss possibly resulting from ischemic optic neuropathy. Conclusions Nontraumatic subperiosteal orbital hemorrhage may occur at any age, usually secondary to sudden elevation in venous pressure. It is nearly always superior. The clinical and radiologic features are sufficiently characteristic to allow conservative treatment in the absence of visual compromise.

Purpose: Cataract surgery is increasing in Australia and represents a significant burden on limited health resources. This study examines the frequency and outcomes of cataract surgery for patients who were hospitalized overnight compared with those treated as day surgery cases. Methods: Medical records of 671 consecutive admissions for cataract surgery at the Royal Victorian Eye and Ear Hospital were reviewed. Data analysed included demographic features, insurance status, length of hospitalization, ophthalmic conditions, medical conditions, social problems and planned surgical technique. Ophthalmic and anaesthetic complications, active ophthalmic and medical interventions were also studied. Results: Of the 671 patient admissions for cataract during the study period, 226 (33.4%) were hospitalized overnight. Factors significantly associated with overnight hospitalization in univariate analyses include older age, female sex, country residence, Veterans’ Affairs insurance, monocular vision status, pre-existing ischaemic heart disease, pre-existing asthma/chronic obstructive lung disease, absence of carer, transportation problems, planned extra-capsular cataract extraction technique, ophthalmic complications and active ophthalmic and/or medical interventions. After adjusting for possible confounding factors using backwards stepwise multivariate logistic regression models all except pre-existing ischaemic heart disease and opthalmic complications were significantly associated with overnight admission for cataract surgery. In total, 14 cases (2.1%) needed active ophthalmic and/or medical interventions, 13 overnight cases and one day case. Conclusions: These data suggest that many patients who are hospitalized overnight for cataract surgery could be safely treated as day cases. Such a shift in the pattern of care for cataract surgery could provide a significant potential for health care savings.