PMC3306070_01
(A) Ptosis, periorbital ecchymosis and subconjunctival hemorrhage with protrusion of the conjunctiva in the left eye. (B) Left eye proptosis, limitation in ductions, severe subconjunctival hemorrhage and protrusion. (C) Two months after initial presentation, proptosis of the left eye was reduced significantly but conjunctival vessels were still hyperemic.
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On ophthalmologic examination, the right eye was normal but the left eye had no light perception, intraocular pressure (IOP) of 50 mmHg, profound relative afferent pupil defect, severe proptosis, frozen eye, subconjunctival hemorrhage and periorbital ecchymosis (Fig. 1A and 1B). Two months later, she had mild proptosis and congested conjunctival vessels, but visual acuity was unchanged at no light perception (Fig. 1C).
(A) Axial computed tomography scan of the orbit: the left eye is severely proptotic, extraocular muscles are enlarged and an intraocular hemorrhage is noted (arrowhead). (B) Magnetic resonance angiographic view of a spontaneous high flow carotid-cavernous fistula on the left side (arrow).
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Orbital computed topography (CT) scan revealed proptosis, a dilated superior ophthalmic vein, enlarged orbital muscles, and intraocular hemorrhage (Fig. 2A). Magnetic resonance angiography (MRA) and selective carotid angiography showed a high flow arteriovenous shunt (Fig. 2B).