Presenting Characteristics for Symptomatic, as Compared to Asymptomatic (assumed), Orbital Cavernous Venous Malformations.

Abstract

To compare the characteristics for symptomatic and asymptomatic orbital cavernous venous malformations (OCVMs). A retrospective case-note review for patients with OCVMs was performed for demographics and presenting features. Four hundred and fourteen patients (258 female; 62%) presented at a mean age of 49.4 years and all were unilateral. Ninety-two (22%) asymptomatic OCVMs were found a decade later than 322 symptomatic patients (57.8 vs. 47.0 years; p < 0.001). Patients with symptomatic OCVMs had an average symptom duration of 3.3 years with the commonest being altered vision (57%), proptosis (55%), orbital ache (21%), and diplopia (13%). Visual obscurations were reported by 11% of symptomatic patients, whereas 30% had a hyperopic shift.Mean LogMAR was 0.39 for symptomatic OCVMs and 0.1 for asymptomatic ( p < 0.001), and a relative afferent pupillary defect was detected in 38% symptomatic and 7% asymptomatic patients ( p < 0.001). Mean relative exophthalmos was 3.9 mm in symptomatic patients and 1.5 mm in asymptomatic ( p < 0.001), but there was no correlation between age and exophthalmos. Symptomatic lesions had higher rates of nonaxial displacement (30% vs. 7%; p < 0.00001), more palpable masses (17% vs. 2%; p = 0.0001), and more impairment of motility (29% vs. 10%; p = 0.0024). Fundal abnormalities were noted in 63% of patients with symptomatic OCVMs, as compared to 26% of asymptomatic ( p < 0.0001). Symptomatic OCVMs may present with reduced visual function, either due to the globe or optic nerve compression, or proptosis. Asymptomatic (presumed) OCVMs- representing 22% of all OCVMs-are usually found a decade later than symptomatic lesions, and a few may have only mild functional impairment.