Abstract 351: Orbital Ischemia Syndrome In A Patient With Carotid Artery Dissection

Abstract

Introduction: Orbital ischemia syndrome is a very rare presentation of ocular ischemic syndrome. The cause is usually vascular pathology in the carotid artery, most often on the basis of atherosclerosis or, more rarely, dissection of the carotid artery. Our aim is to draw attention in the form of a case report to an unusual clinical manifestation of carotid artery dissection. Methods: The case report deals with a patient (male, 49 years old) who suffered from intense pain behind the right eye. After a few days of pain, he arrives at the emergency room, where he was sent by a neurologist to the CTA. Preocclusive dissection of the right carotid artery was diagnosed. Neurosonological examination shows a massive reverse flow in the right ophthalmic artery. The pain behind the eye was so intense in the following days that opiate therapy was necessary. Results: Carotid dissection was treated with anticoagulant therapy and a statin. According to the control CTA, the dissection heals at three-month intervals. Neurosonological control also shows normalization of flow in the right ophthalmic artery. The decrease in residual pain intensity even on analgesic therapy correlated with a decrease in the amplitude of retrograde flow in the ophthalmic artery. Conclusion: Painful presentation of ocular ischemic syndrome, moreover caused by carotid artery dissection, is very rare.. However, if intense periorbital pain is present, carotid artery CTA should always be performed as part of the diagnostic proces.