Ophthalmoscopic findings in spontaneous carotid cavernous fistula: An analysis of 20 patients

Abstract

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.

Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity

“…In a later phase of the disease, the small capillary connections are opened on the outside of the orbit with enlarged connections on the eyeball itself between the recurrent conjunctival ciliary veins and posterior conjunctival veins (specific limbal loops) 2,3,5 and can include the possibility of a secondary glaucoma associated with elevated episcleral pressure. 18,19 Using slit-lamp biomicroscopy, this condition can be recognized and identified by the appearance of typical vascular loops and by the normal aspect of the episcleral and conjunctival tissue between the loops. Blood flow in the recurrent anterior conjunctival veins is reverse and -in most cases -higher to the now newly developed connections of the posterior conjunctival veins (Figure 2a, b).…”

Choroidal Detachment Associated with Direct Spontaneous Carotid-Cavernous Sinus Fistula

“…We could find only 7 similar cases in a review o f the literature [2][3][4][5]. The first case reported by Woillez et al [4] was a unilateral posttraumatic, direct, high-flow CCSF with choroidal detachment occurring in the ipsilateral eye fol lowing a third surgical procedure.…”

“…Harbison et al [2] de- scribed the second case who had bilateral low-flow dural CCSF with choroidal detachment. Jergensen and Guthoff [3] documented 4 cases of choroidal detachment as a clin ical manifestation of spontaneous dural CCSF among 20 patients. Two of them developed exudative retinal detach ment.…”

“…The combination of reduced ar terial perfusion and raised venous pressure creates orbital and ocular hypoxia. The resulting fistula can produce ex ophthalmos, pain, redness, diplopia and increased intraoc ular pressure [1][2][3]. Spontaneous dural fistulas have a rela tively mild clinical course compared with direct fistulas.…”

“…A carotid-cavernous sinus fistula (CCSF) is an abnormal communication between a branch of the carotid artery and a cavernous sinus [1][2][3]. Clinically and angiographically, CCSFs can be subdivided as spontaneous or traumatic, high or low flow, direct or dural.…”