Carotid cavernous fistula masquerading as orbital cellulitis

We report a case of direct carotid cavernous fistula (CCF) in a patient of head injury due to road traffic accident who presented several weeks after the injury with sudden onset of pain, redness, and proptosis of right eye. A 56 years old male patient with no known comorbidities presented to ophthalmology OPD with acute onset of pain, redness, swelling, and proptosis of right eye of one week duration and visual acuity of 1/60. Initially he was misdiagnosed and treated as orbital cellulitis. However, digital subtraction angiography confirmed the diagnosis of right direct CCF. Patient underwent endovascular treatment with a good visual recovery post operatively. Ophthalmologists should keep CCF higher up in their differential diagnosis of patients with red edematous eyes, especially with a history of trauma and get thorough investigations in order to provide timely aggressive management to such patients.