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VASCULAR ORBITAL DISORDERS

VASCULAR ORBITAL DISORDERS. 1. Orbital venous anomalies (varices). Isolated orbital varices Combined orbital and external varices. 2. Carotid-cavernous fistula. Direct Indirect. Orbital venous anomalies (varices). Congenital enlargements of pre-existing venous channels

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VASCULAR ORBITAL DISORDERS

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  1. VASCULAR ORBITAL DISORDERS 1. Orbital venous anomalies (varices) • Isolated orbital varices • Combined orbital and external varices 2. Carotid-cavernous fistula • Direct • Indirect

  2. Orbital venous anomalies (varices) • Congenital enlargements of pre-existing venous • channels • Usually unilateral • May bleed or become thrombosed

  3. Isolated orbital varices Intermittent proptosis Precipitated or accentuated by Valsalva manoeuvre Non-pulsatile, without a bruit

  4. Combined orbital and external varices Conjunctival varices Eyelid varices Precipitated or accentuated by Valsalva manoeuvre

  5. Direct carotid-cavernous fistula • Defect in intracavernous part of internal carotid • Rapid flow shunt Causes • Head trauma - most common • Spontaneous rupture - in hypertensive females • Ptosis, chemosis and conjunctival injection • Ophthalmoplegia • Raised intraocular pressure

  6. Direct carotid-cavernous fistula • Pulsatile proptosis with bruit • and thrill • Abolished by ipsilateral • carotid compression • Retinal venous congestion and haemorrhages

  7. Indirect carotid-cavernous fistula (dural shunt) • Indirect communication between meningeal branches of internal • or external carotids and cavernous sinus • Slow flow shunt Causes • Congenital malformations • Spontaneous rupture • Occasional ophthalmoplegia • and mild proptosis • Dilated episcleral vessels • Raised intraocular pressure with • wide pulsation

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