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Rebecca M Sieburth, Julie A Matsumoto, Steven A Newman; Orbital varices. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5608. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Examine the clinical characteristics, natural history, imaging, and necessity of treatment in patients with orbital varix.
A retrospective review of 18 patients coded as orbital varix. Charts were reviewed. Charts and films were reviewed by both a neuroradiologist and a neuro-ophthalmologist.
Of 18 cases, 11 (61%) were female and 7 (39%) were male, averaging 59 years of age. Nine (50%) presented acutely, and 6 (33%) presented with positional symptoms. Common presenting complaints included periorbital pain or pressure (n=10; 56%), proptosis (n=7; 39%), double vision (n=7; 39%), blurry vision (n=5; 28%), and eyelid swelling (n=3; 17%). Best corrected visual acuity ranged from 20/20-20/60 on the affected side. Six (33%) demonstrated an afferent pupillary defect ranging from 0.3-0.9 log units. Proptosis was identified in 12 (67%), 6 (33%) of whom presented with complaints of prominent globe. Resistance to retropulsion was present in 5 (28%). Maddox rod identified extraocular movement abnormalities in 15 (83%); Hess screen confirmed extraocular motility abnormalities in 10 (56%). Except in one case of ipsilateral branch retinal artery occlusion (BRAO), optical coherence tomography (disc and macula) and automated perimetry did not reveal significant abnormalities. Concurrently, with the exception of one ipsilateral BRAO and one contralateral disc hemorrhage, dilated fundus examination was normal, without optic disc edema, pallor, or retinal striae. Most orbital varices were solitary lesions, with the exception of one bilateral case. Review of available imaging demonstrated 1 cavernous hemangioma, 1 low flow vascular malformation, 8 orbital varices, and 4 in which the diagnosis was unclear based on imaging alone. In all cases symptoms improved with observation. No patients required surgical intervention.
Imaging characterization of orbital vascular malformations is not always straightforward, although hemangioma is usually apparent. It is important to differentiate other vascular malformations from varix. Newer imaging modalities, including time-resolved contrast-enhanced magnetic resonance angiography, may be of special utility in characterizing orbital varices. Surgical intervention is often not required. Even in cases with sudden proptosis or symptom exacerbation due to presumed intralesional thrombosis or hemorrhage, significant symptom resolution occurred with observation alone.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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