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Massive exophthalmos after traumatic carotid-cavernous fistula embolization.

Authors
Type
Published Article
Journal
Orbit (Amsterdam, Netherlands)
Publication Date
Volume
26
Issue
2
Pages
121–124
Identifiers
PMID: 17613860
Source
Medline

Abstract

An 18-year-old man without previous clinical problems developed a left traumatic carotid-cavernous fistula after a traffic accident. An endovascular embolization with coils was performed without success. The drainage was derived to the superior ophthalmic vein solely and clinical worsening occurred. Left eye proptosis, chemosis and intraocular pressure increased. Complete ophthalmoplegia developed and visual acuity decreased due to a central retinal vein obstruction. After a second embolization attempt the fistula was closed successfully but proptosis, chemosis and intraocular pressure remained uncontrolled despite medical treatment. Therefore an orbital decompression surgery was performed. Ophthalmoplegia, proptosis and chemosis improved and intraocular pressure was controlled. Although retinal hemorrhages persist, no neovascularization has developed. Central retinal vein occlusion in young patients seems to have a different etiology than in the elderly. In young patients, local factors are more frequently identified than systemic vascular diseases. Early detection of central retinal vein obstruction may prevent deterioration of visual acuity.

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