Management of a patient with orbital varices, visual loss, and ipsilateral glaucoma

A man with congenital orbital varices developed progressive ipsilateral visual loss beginning at age 62. Work-up demonstrated elevated intraocular pressure, decreased outflow facility, and mildly elevated episcleral venous pressure in the affected eye. Initiation of adequate glaucoma treatment was associated with interruption of declining visual acuity and with expansion of the constricted visual field. Medical control of coexisting glaucoma should be attempted prior to consideration of surgical intervention in any patient with visual loss and an ipsilateral orbital varix.