Orbital Venous Varices: A Rare Bilateral Asymptomatic Presentation

Abstract

This report illustrates a case of asymptomatic bilateral orbital varices in a 64-year-old Caucasian male. The orbital varices were incidentally discovered while investigating the patient’s initial presentation of bilateral chorioretinal scars and optic nerve head drusen. Magnetic resonance imaging (MRI) of the brain and orbits with contrast confirmed the presence of bilateral varices of the inferior ophthalmic veins and pterygoid plexuses. The occurrence of bilateral orbital varices is quite rare, and few asymptomatic cases have been described in the literature.

The Clinical Case of Idiopatic Dilatation of Epibulbal Veins

“…Экзофтальм может значительно усиливаться при маневре Вальсальвы и исчезать, если устранен венозный застой [6,7]. По данным зарубежных авторов, описанная патология может протекать бессимптомно в связи с малыми размерами венозных образований [8]. В литературе описаны случаи проявления кавернозной гемангиомы орбиты, капиллярной гемангиомы изолированными спонтанными гипосфагмами на фоне полного здоровья [9,10].…”

Orbital Tumors—Clinical, Radiologic and Histopathologic Correlation

“…They account for less than 2% of all orbital tumors [ 29 ]. They typically occur unilaterally but bilateral manifestation is also possible [ 30 ]. Orbital varices are primarily congenital and may stem from dilatation of only a single or, alternatively, multiple venous vessels.…”

Behind an acrobat’s eye

“…Most orbital varicosities are asymptomatic and compliant with conservative management with serial imaging followup. 10 Surgery is required in the presence of disfiguring proptosis, severe pain and vision loss related to optic nerve compression. 3 Excision of the varix via a transconjunctival anterior orbitotomy approach is the treatment of choice.…”

“…12 Recurrences usually occur because of an incomplete excision secondary to the inability to elicit venous distension during surgery. 10 To avoid subtotal excision, the surgeon must excise the varix as close to the orbital apex as possible. In cases of posterior or deeper varices, embolisation with microcoils, as well as glue and/or n-Butyl cyanoacrylate injection may be performed to reduce intraoperative bleeding.…”

“…In cases of posterior or deeper varices, embolisation with microcoils, as well as glue and/or n-Butyl cyanoacrylate injection may be performed to reduce intraoperative bleeding. 2,10 CASE CONTINUED…”