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Related Experiment Videos

A red eye and then a really red eye.

M Tariq Bhatti1, Keith R Peters

  • 1Departments of Ophthalmology and Neurology, University of Florida College of Medicine, Gainesville, FL, USA.

Survey of Ophthalmology
|April 11, 2003
PubMed
Summary

A rare case of carotid-cavernous sinus fistula (CCF) presented as persistent conjunctivitis. Prompt diagnosis and intervention resolved this ophthalmic emergency.

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Area of Science:

  • Ophthalmology
  • Neurology
  • Vascular Surgery

Background:

  • Carotid-cavernous sinus fistulas (CCF) are abnormal connections between the carotid artery and the cavernous sinus.
  • CCF can present with diverse ocular symptoms, sometimes mimicking common conditions like conjunctivitis.

Observation:

  • A 90-year-old woman presented with a 4-week history of conjunctivitis resistant to antibiotics.
  • Ocular findings included tortuous conjunctival vessels, retinal hemorrhages, and an orbital bruit.
  • Rapidly worsening symptoms included a painful, swollen eye and severely elevated intraocular pressure.

Findings:

  • Cerebral arteriogram confirmed a direct carotid-cavernous sinus fistula (CCF).
  • Successful treatment involved a right carotid artery cut-down with balloon occlusion due to complex vascular anatomy.
  • The intervention led to prompt resolution of the fistula and orbital congestion.

Implications:

  • Carotid-cavernous sinus fistula (CCF) should be considered in atypical red eye presentations.
  • Ocular signs like arteriolized conjunctival vessels and orbital bruits are crucial diagnostic clues.
  • Early recognition and management of CCF are vital to prevent vision loss and manage this ophthalmic emergency.

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