Clinical Profile and Visual Outcomes of Pre- and Postembolization of Carotid-cavernous Fistula-induced Glaucoma.
Siddhartha Gollamudi, Chetana Dalapathirao, Renu Magdum et al.
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Case in brief
A 70-year-old man presented with progressive left eyelid swelling, orbital congestion, and inability to open the eye. Examination showed severe conjunctival chemosis, dilated episcleral vessels, an intraocular pressure of 20 mmHg, and corneal Descemet’s folds. Imaging demonstrated a left sphenoid arteriovenous fistula draining into the superior ophthalmic vein. After endovascular embolization, he received topical dorzolamide and beta-blockers plus oral acetazolamide for pressure control. Orbital congestion and eyelid function improved, intraocular pressure stabilized, and visual acuity improved from counting fingers to 6/12, with optic nerve function preserved.
What made this case unusual
The fistula’s drainage into the superior ophthalmic vein was associated with marked orbital congestion and secondary glaucoma, while visual acuity improved substantially after embolization and medical pressure control.
Diagnostic / clinical pearl
In a patient with unilateral orbital congestion, chemosis, and dilated episcleral vessels, consider a carotid-cavernous fistula; assess and manage secondary intraocular pressure elevation alongside fistula treatment.
Why it matters
The reported visual recovery followed coordinated care by ophthalmology and interventional radiology, underscoring the value of addressing both the fistula and its ocular complications.