J Korean Ophthalmol Soc.  2020 Apr;61(4):449-453. 10.3341/jkos.2020.61.4.449.

Carotid-cavernous Fistula Accompanied by Superior Ophthalmic VeinThrombosis

• Na JH
• Lee SJ

• KMID: 2500114
• DOI: http://doi.org/10.3341/jkos.2020.61.4.449

Abstract

Purpose
To report a case of carotid-cavernous fistula associated with superior ophthalmic vein thrombosis which was misdiagnosed as orbital cellulitis.
Case summary
A 72-year-old female was transferred to our hospital because she had been diagnosed with orbital cellulitis at another hospital due to pain, swelling, and redness of the left eye, which became increasingly severe 3 days prior to her visit. The patient had edema and ptosis of the left eyelid, severe chemosis, and congestion of the conjunctiva. The eye movement test showed limitations in abduction, adduction, and infraduction of the left eye, and the patient complained of diplopia. Paranasal sinus computed tomography showed an edema of the left upper eyelid, enlargement of the extraocular muscles, and dilation and thrombosis of the superior ophthalmic vein. On brain magnetic resonance imaging and magnetic resonance angiography, left carotid-cavernous fistula was suspected, so she was transferred to neurosurgery and a cerebral angiography was performed. Cerebral angiography showed an indirect carotid-cavernous fistula on the ipsilateral side and a direct carotid-cavernous fistula on the opposite side. The patient underwent embolization and stenting. Seven days after surgery, the eyelid and conjunctival swelling and diplopia disappeared and there was no limitation of eye movement in any direction.
Conclusions
An infectious disease such as orbital cellulitis is the most common cause of superior ophthalmic vein thrombosis. However, as in this patient, carotid-cavernous fistula can be the cause, so thorough imaging is important for rapid improvement of symptoms.

Keyword

Carotid-cavernous fistula; Orbital cellulitis; Superior ophthalmic vein thrombosis