Postural exophthalmos caused by orbital varix

Abstract

Purpose: To describe a clinical case of unilateral and intermittent exophthalmos of subacute onset and persistent course. Methods: A 43‐year‐old woman who was referred to the orbit section due to a sensation of protrusion of the left eye (LE) that increases when bending down. Shee also reports that she hears an intermittent murmur. It is not accompanied by eye pain or blurred vision. She evidenced it a few months ago, not being related to any traumatic event. She has no personal or family history of interest. It was observed with the patient sitting that the LE seemed to protrude more than the RE. Exophthalmometer measurement revealed a 2 mm proptosis. When the patient was lying on her left side, the exophthalmos increased as the minutes passed. It was a reducible but not pulsatile exophthalmos. No murmur was observed during the examination. The rest of the ophthalmological examination showed no alterations. Given the suspicion of intermittent exophthalmos due to a left orbital tumour, it was decided to perform a contrast‐enhanced CT scan that revealed a varicose venous lesion with an intraconal component and slight extraconal prolongation in the Valsalva sequences. Results: Due to the difficult surgical access, the small size and the mild symptoms, having ruled out the presence of haemorrhage, varicose thrombosis or compression of the optic nerve, it was decided to carry out clinical follow‐up. Conclusions: Clinical suspicion of orbital varicocele in a case with typical symptoms is essential. Orbital CT with contrast in Valsalva sequences is one of the most used diagnostic test. Good clinical follow‐up is necessary in cases with mild symptoms. References Howells MS, Sharma R. Orbital varices. BMJ Case Rep. 2019;12(12):e232887. doi: 10.1136/bcr‐2019‐232 887. PMID: 31818898; PMCID: PMC6904158. Shchurova IN, Pronin IN, Melnikova‐Pitskhelauri TV, Serova NK, Batalov AI, Solozhentseva KD. Orbital'nyi venoznyi varikoz: sovremennye metody diagnostiki i differentsial'nyi diagnoz [Orbital venous varices: modern diagnostic methods and differential diagnosis]. Zh Vopr Neirokhir Im N N Burdenko. 2020;84(6):33–48. Russian. doi: 10.17116/neiro20208406133. PMID: 33306298.