Unilateral Exophthalmos as the First Sign of Chronic Obstructive Hydrocephalus in a Pediatric Patient: A Case Report

Orbital complications are rare manifestations of congenital hydrocephalus. We present a case of a child presenting with unilateral exophthalmos and palpebral edema as a result of a chronic increased intracranial pressure and severe enlargement of the ventricular system. The initial presentation in our 13-year-old male patient was progressive right eyelid swelling. Echo-sonography showed right eyelid edema while computed tomography revealed internal hydrocephalus and cerebral edema. In the later course, an enlarging right bulb protrusion occurred, which was repositioned immediately after placing a ventriculoperitoneal shunt. The right eyelid edema decreased in the week following the procedure. The postoperative status was confirmed by magnetic resonance imaging, which also showed a right orbital roof defect. The observed orbital roof defect was considered a cause of the eye bulb protrusion in this case and highlights the possibility of orbital signs as the first manifestations of non-traumatic obstructive hydrocephalus in children.