Carotid cavernous fistula masquerading as orbital cellulitis

Area of Science:

• Ophthalmology
• Neurology
• Radiology

Background:

• Head injuries from road traffic accidents can lead to delayed complications.
• Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus.

Observation:

• A 56-year-old male presented with acute right eye pain, redness, swelling, and proptosis weeks after a head injury.
• Initial misdiagnosis as orbital cellulitis occurred.
• Visual acuity was significantly reduced to 1/60.

Findings:

• Digital subtraction angiography confirmed a direct carotid cavernous fistula (CCF) of the right side.
• The patient underwent successful endovascular treatment.

Implications:

• Ophthalmologists should consider CCF in the differential diagnosis for red, edematous eyes, especially with a history of trauma.
• Timely and thorough investigations are crucial for effective management and visual recovery.