Bone infarctions can occasionally involve the orbit, presenting with subperiosteal hematomas and mimicking infectious or neoplastic processes. We report a case of bilateral orbital bone infarctions complicated by subperiosteal hematomas in a child with sickle cell disease during a vaso-occlusive crisis. The diagnosis of subperiosteal orbital hematoma was established by computed tomography. Differentiating infection on imaging was essential to guide management. Surgical decompression was performed, leading to marked clinical improvement and relief of optic nerve compression. This case illustrates the importance of prompt diagnosis and intervention in rare orbital complications associated with hemoglobinopathies.