Exophthalmos secondary to a carotid cavernous fistula

Exophthalmos secondary to a carotid cavernous fistula

Contributor: Brittni A. Scruggs, MD, PhD

Photographer: Cynthia Montague

Category(ies): Neuro-ophthalmology, Glaucoma

Posted: September 26, 2017

A carotid-cavernous fistula (CCF) is a pathologic shunt between the carotid artery and the venous cavernous sinus; such hemodynamic lesions often lead to the triad of exophthalmos, epibulbar arterialized loops, and glaucoma. Diagnosis is by clinical examination, computed tomography or magnetic resonance angiography, and/or catheter angiography. A direct CCF (type a) connects the intracavernous portion of the internal carotid artery (ICA) to the sinus, whereas indirect, or dural, fistulas (type b) are low-flow fistulas that connect ICA branches to the cavernous sinus (1). If vision-threatening signs develop, then embolization must be considered.

References:

1. R.J.W. Keizer (2003) Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity, Orbit, 22:2, 121-142

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