Angle-Closure Glaucoma due to Lens Subluxation Associated With Orbital Arteriovenous Malformation

Orbital arteriovenous malformations (AVMs) are rare vascular anomalies that typically progress gradually. This case presents an unusual acute presentation of orbital AVM causing angle-closure glaucoma in a 48-year-old Korean male. He presented with severe left ocular pain, proptosis, and vision loss for 2 days. Examination revealed elevated intraocular pressure associated with crystalline lens subluxation into the anterior chamber and restricted extraocular movement. Imaging studies confirmed an intraorbital AVM. Urgent endovascular embolization using Onyx was performed, followed by phacoemulsification with scleral-fixated intraocular lens implantation. His condition gradually improved, with the resolution of strabismus and normalization of intraocular pressure. Long-term follow-up 6 years postintervention demonstrated stable visual acuity, normal intraocular pressure, and no AVM recurrence. This case underscores the importance of considering orbital AVMs in acute unilateral proptosis with angle-closure glaucoma. It emphasizes the possible coincidence of AVM and lens-induced angle closure and the importance of early diagnosis and intervention for optimal outcomes.