The pathophysiological influence of spontaneous carotid cavernous fistula (CCF) on retinal/orbital circulation is discussed. Of 20 patients, 1 case of papilloedema, 4 of choroidal detachment (CD), 2 of exudative retinal detachment (ERD) and 3 cases of central venous thrombosis (CVT) were seen, associations that on rarely reported in the literature. An elevation in the episcleral venous pressure was measured that was more than twice the normal, which explains the ophthalmoscopic findings.
Between 1983 and 1987 the authors studied 64 patients with dilated episcleral vessels and open-angle glaucoma. Elevated episcleral venous pressure was found to be the cause of the increased intraocular pressure. Clinically, the cause of elevation of venous pressure included spontaneous carotid cavernous fistulas, Sturge-Weber syndrome, orbital tumors, endocrine exophthalmos, anterior scleritis and idiopathic cases. A variety of pathophysiological mechanisms causing elevated episcleral venous pressure were found. The clinical course and complications associated with elevated episcleral venous pressure are discussed.
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