# An Atypical Presentation of Disseminated Intravascular Coagulation Following Ocular Interventions for Proliferative Diabetic Retinopathy: Mimicking Retrobulbar Hemorrhage

## TL;DR

A man with diabetes developed a rare blood clotting disorder after eye treatments, mimicking a different condition and requiring urgent care.

## Contribution

This is the first reported case of disseminated intravascular coagulation following ocular interventions.

## Key findings

- DIC occurred after panretinal laser and Bevacizumab injections in a patient with diabetes.
- DIC symptoms included eye pain, swelling, and low platelet count, but no retrobulbar hemorrhage was found.
- The case highlights the need for careful monitoring of diabetic patients post-ocular procedures.

## Abstract

A 42-year-old man with poorly controlled diabetes mellitus, hypertension, chronic kidney disease, and a diabetic foot received treatment with panretinal laser photocoagulation in his right eye and intravitreal injection of Bevacizumab in both eyes to manage proliferative diabetic retinopathy accompanied by diabetic macular edema in the right eye and complicated by vitreous hemorrhage in the left eye. He then presented on the same day with right eye pain, eyelid swelling, ecchymosis, and subconjunctival hemorrhage. Additionally, he showed right-sided signs suggestive of facial palsy. Laboratory tests revealed a significantly low platelet count. Orbital and brain imaging ruled out retrobulbar hemorrhage and ischemic insults. A referral was made to a tertiary hospital for further evaluation and treatment of suspected disseminated intravascular coagulation (DIC) by a multidisciplinary team. To the best of our knowledge, the development of DIC after ocular procedures has not been previously reported. We recommend careful management of patients with poorly controlled diabetes and kidney disease to prevent further systemic complications.