Ophthalmic artery aneurysm.

Abstract

Aneurysm of the ophthalmic artery is quite uncommon and its preoperative demonstration has rarely been reported. Kinley and Leighninger (1) published a case of traumatic aneurysm in the region of the ophthalmic artery secondary to a compound comminuted fracture of the frontal bone involving the supra-orbital ridge and roof of the orbit. They were able to demonstrate the aneurysm by angiography two months after the injury. Their case may, however, have been a variant of a carotid-cavernous aneurysm, rather than an aneurysm of the ophthalmic artery. We have found no other instance in which the aneurysm was visualized preoperatively. The present case occurred without trauma and was discovered on angiography. Changes in the optic foramen seen on the plain films might have led one to suspect the specific diagnosis of ophthalmic artery aneurysm. Case Report A fifty-year-old female was admitted to the Miriam Hospital with progressive visual loss in the left eye of three months duration. At that time she was recovering from an upper respiratory infection and complained of severe headaches, followed by blurring of vision. Her vision became progressively worse, dropping from 20:20 to 20:400. She was seen by three ophthalmologists who felt that her symptoms were caused by retrobulbar neuritis. Vision in the right eye was absent as a result of a childhood injury to the right globe and a cataract of the right lens. Hypertension was discovered two years previously and with diet her weight declined from 217 to 178 pounds. Examination of the right eye revealed a dense lenticular opacity which allowed light perception, but no projection of the position of the light. With the left eye, the patient could detect only shape and movement. There was nasal hemianopsia on the left. Funduscopically there were marked pallor of the temporal portion of the optic disk and normal coloration of the nasal portion. The right disk could not be visualized because of lenticular opacity. The extraocular movements were unimpaired. There was some puffiness of the left lid as compared with the right. No pulsations nor bruits were elicited on auscultation of the skull or eyeballs. Both pupils reacted to light and the left to accommodation. There was no nystagmus. Heart and lungs were normal. Pulse, temperature, and respirations were normal. Blood pressure 150/80. Neurologic examination revealed normal reflexes and muscle tone. There were no sensory changes. A blood count was as follows: hemoglobin 12 gm.; red cells 4,000,000; white cells 8,600 with a normal differential count. The urine showed specific gravity of 1.020, no albumin or sugar, and a trace of acetone. Urinary sediment was normal. The routine skull films presented no abnormal findings. Studies of the optic foramina revealed extensive erosion on the left (Fig. 1).