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To describe a series of patients presenting with sudden onset of localised, non-traumatic haemorrhage from spontaneous rupture of superior ophthalmic vein (SOV).

A retrospective review of six patients with a diagnosis of acute spontaneous rupture of SOV. The pattern of presentation, clinical implications and outcomes, as well as the characteristic imaging and histological features are described.

Six patients (5 men; 84%) presented at a mean age of 45 years, with the commonest symptoms and signs being acute onset of Valsalva-negative proptosis (mean 3.3mm; range 0-7mm), orbital pain and diplopia. Two patients developed optic neuropathy. Imaging revealed a well-defined, ovoid, homogenous soft-tissue mass above (2 cases) or superomedially to the SOV; The masses were typically echogenic on B-mode ultrasonography, and there was no detectable internal blood-flow. Resolution of signs and symptoms was noted in 5 patients over an average of 4.6 months (range 3-7 months), whilst one patient – the youngest — required excision of a persistent and increasing mass.

Spontaneous blowout of the SOV is a rare cause of acute non-traumatic orbital haemorrhage. In most cases the clinical signs slowly improve over several months, surgical intervention is generally not required, and recurrence is infrequent.