[Traumatic ophthalmic artery-superior ophthalmic vein fistula: a case report]

Traumatic intraorbital arteriovenous fistula is rare and only 2 cases have been reported. The authors report the case of a 70-year-old man with consciousness disturbance after non-penetrating head injury. CT scan showed diffuse subarachnoid hemorrhage in the basal cistern, and angiography on the next day revealed ophthalmic artery-superior ophthalmic vein fistula in the right orbit. During the clinical course of this lesion, there was mild chemosis of the right eye, without palsy of extraocular muscles. Both papilledema and bruit were absent. Conservative treatment was chosen. On the 26th day after the head injury, repeated angiography showed complete disappearance of the fistula. The patient was discharged on the 39th day without neurological deficit. In the other two reported cases, intraorbital A-V fistulae were caused by direct-penetrating injury. But, in the present case the head injury was non-penetrating and blunt type. The pathogenesis was considered to be indirect injury of the intraorbital vessels at the retrobulbar portion, approximately where the artery and the vein crossed. As regards to treatment, simple observation may be the first choice, and spontaneous obliteration can be expected. If this does not occur, either embolization or ligation of the ophthalmic artery is suggested as the second choice as proposed by Freitas MAL et al.