[Progressive exophthalmos in bilateral carotid-cavernous fistula and accompanying venous sinus thrombosis]

We report the case of a 73-year-old female patient with progressive exophthalmos and temporal inferior malposition of the eye with limited bulbar motility and left hemifacial cramps at our ophthalmology clinic. Physical examination also revealed ocular redness and a chemotic conjunctiva with venous congestion in the left eye. Sonography showed an enlarged superior ophthalmic vein. Clinical suspicion of a carotid-sinus-cavernous fistula (CCI) was confirmed by imaging (MRI and DSA), and the presence of a contralateral carotid-cavernous fistula was noted. Secondary imaging findings included thrombosis in both cavernous sinus and the superior sagittal sinus. Due to the lack of a history of trauma, the CCI was discussed as a result of sinus thrombosis. Following deliberation at our interdisciplinary, neurovascular, multiprofessional case conference, the decision was taken to implement conservative antithrombotic therapy for the fistula and sinus vein thrombosis, with regular clinical and imaging follow-up examinations. This complex case illustrates the ophthalmological symptoms and findings of carotid sinus cavernous fistula and the need for good interprofessional collaboration between ophthalmology, neuroradiology and neurosurgery.