Orbital Varix Research Articles

Electrophysiological changes associated with optic nerve compression caused by the distension of orbital varices

Electrophysiological changes associated with optic nerve compression caused by the distension of orbital varices

Vascular Lesions of the Orbit: More than Meets the Eye

Vascular lesions of the orbit may be classified on the basis of their natural history, growth pattern, and histologic composition as capillary hemangiomas, venous vascular malformations, venous lymphatic malformations, arterial and arteriovenous lesions, or neoplasms. Most follow a characteristic pattern of clinical development and have one or more specific imaging features that allow diagnosis. Hemangiomas typically manifest at or soon after birth and subsequently involute. They are nonencapsulated, poorly circumscribed, often lobulated, and largely extraconal in location. Cavernous malformations are septate and well circumscribed, may exhibit progressive enhancement on delayed images, and do not involute. Orbital varices appear distended on images obtained with the patient prone or during the Valsalva maneuver. Venous lymphatic malformations show multiple fluid-fluid levels, enlarge during viral infections, and may manifest as chocolate-colored cysts after an acute hemorrhage. Arteriovenous malformations, fistulas, and aneurysms have typical angiographic features. Hemangiopericytomas arise from the paranasal sinuses and show early tumor blush and persistent staining on angiographic images. Hemangioblastomas appear as enhancing mural nodules with associated cysts and serpentine flow voids on magnetic resonance (MR) images. Choroidal hemangiomas and melanomas can be differentiated on the basis of their appearances on T2-weighted MR images. Patients with vascular orbital and ocular metastases commonly have a history of breast or lung primary tumors.

Noninvasive Dynamic Magnetic Resonance Angiography With Time-Resolved Imaging of Contrast KineticS (TRICKS) in the Evaluation of Orbital Vascular Lesions

To evaluate the clinical utility of time-resolved contrast-enhanced magnetic resonance angiography (MRA) in the evaluation of vascular orbital tumors. Retrospective medical record review of patients with vascular orbital lesions imaged with Time-Resolved Imaging of Contrast KineticS (TRICKS; GE Healthcare [Chalfont St Giles, England]) MRA, a noninvasive dynamic imaging modality. Five patients with orbital vascular tumors were evaluated using TRICKS MRA. These included 1 patient with a cavernous hemangioma, 2 patients with orbital varices, 1 patient with an orbitocutaneous arteriovenous malformation, and 1 patient who had a solitary fibrous tumor with features of a hemangiopericytoma. In 2 patients, diagnoses were altered as a result of TRICKS MRA. In addition, a young patient with a large orbitocutaneous arteriovenous malformation involving the ophthalmic artery was followed perioperatively and noninvasively using TRICKS MRA, which produced exquisite images and added substantial value in the care of these patients. Dynamic MRA in the form of TRICKS is a newly available imaging modality with great potential for improving the evaluation and management of patients with complex orbital tumors.

Meningoencephalocele Presenting as Orbital Varix: A Complication of Frontal Sinus Trephine

Meningoencephalocele Presenting as Orbital Varix: A Complication of Frontal Sinus Trephine

O.481 Acute thrombosis of an orbital varix. A high risk of blindness

O.481 Acute thrombosis of an orbital varix. A high risk of blindness

Coil embolization of a congenital orbital varix in a dog

A 10-week-old Labrador Retriever was examined because of a swelling above the left eye. Ophthalmic examination revealed a tubular, light-pink, slightly raised lesion of the left conjunctiva that extended from the limbus to the fornix and into the dorsal eyelid. The lesion affected the entire margin of the dorsal eyelid and extended 2 cm dorsal to the eyelid margin. With compression of the left jugular vein, the exophthalmos worsened immediately and the subconjunctival and eyelid lesion enlarged. Results of ultrasonography, computed tomography, and contrast venography were consistent with a diagnosis of an orbital varix. Coil embolization was elected for treatment of the varix to prevent the pain and morbidity associated with an orbitotomy. Coils were introduced through a 22-gauge IV catheter inserted through the upper eyelid into the varix. The only complication was moderately severe orbital swelling. The owners reported that the lesion had resolved by 2 weeks after coil embolization.

Diagnosis and Anatomic Mapping of an Orbital Varix by Computed Tomographic Angiography

To report the use of computed tomographic angiography (CTA) to diagnose an orbital varix. Observational case report. A 73-year-old female was investigated by CTA for carotid artery stenosis. An incidental orbital lesion was discovered. Reformations were obtained. CTA demonstrated a homogeneously enhancing orbital apex lesion. It provided exceptional anatomic detail of inflow and outflow veins, confirming the diagnosis of an orbital varix. CTA is cost effective, fast, non-invasive, and readily available. These aspects combined with the exceptional vascular detail obtained may make CTA the primary test for orbital varix diagnosis.

Orbital varices diagnosed as episcleritis in a child with juvenile idiopathic arthritis

A 10-year-old girl with juvenile idiopathic arthritis (JIA) was followed in the ophthalmology clinic for 2 years with a diagnosis of episcleritis after recurrent episodes of a unilateral painful eye with left lateral scleral injection. She denied having diplopia, photophobia, headache, or visual loss. Examination revealed a normal fundus and no signs of uveitis. She was treated repeatedly with topical steroids, and each attack settled within a few days. She then presented with a proptosed, red, painful left eye associated with diplopia. Examination revealed temporal scleral injection, proptosis of 7 mm with no signs of uveitis, and a normal fundus. After conservative treatment, her symptoms resolved by day 3. Full blood count, vasculitic screen, and serum ACE were normal. The MRI scan revealed a serpiginous soft tissue structure medial to the left lateral rectus muscle (Figure). A diagnosis of left orbital varices was made. Episcleritis and scleritis are exceptionally rare in definite cases of JIA. Their appearance should initiate a reexamination of the original diagnosis to one more likely to be associated with episcleritis. Arthritis associated with systemic vasculitis, sarcoidosis, or inflammatory bowel disease1Read R.W. Weiss A.H. Sherry D.D. Episcleritis in childhood.Ophthalmology. 1999; 106: 2377-2379Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar may resemble polyarticular JIA with extraarticular features developing several years after the onset of arthritis. These conditions may present with episcleritis or scleritis. Orbital varices usually are seen in children as a dark blue swelling in the superomedial part of the orbit, orbital hemorrhage, proptosis,2Wright J.E. Sullivan T.J. Garner A. Wulc A.E. Moseley I.F. Orbital venous anomalies.Ophthalmology. 1997; 104: 905-913Abstract Full Text PDF PubMed Scopus (134) Google Scholar or intermittent exophthalmos that can be brought on by bending or by the Valsalva maneuver.3Yazici B. Yazici Z. Gelisken O. An unusual case: bilateral orbital varices.Acta Ophthalmol Scand. 1999; 77: 453-455Crossref PubMed Scopus (13) Google Scholar Our patient appeared to have intermittent dilation of the episcleral varix in the absence of noticeable proptosis or exacerbation on the Valsalva maneuver for a few years before symptomatic proptosis occurred. Delays in diagnosis were also compounded by the rare coincidence of this orbital tumor with polyarticular JIA. The difficulties of imaging of low-flow lesions are also exemplified by this case, in which the acute CT scan showed an indistinct soft tissue mass. Despite initial MRI findings, MRI 3 months after acute proptosis did not show varices on venography. Color Doppler ultrasound and orbital venography, however, have been useful.3Yazici B. Yazici Z. Gelisken O. An unusual case: bilateral orbital varices.Acta Ophthalmol Scand. 1999; 77: 453-455Crossref PubMed Scopus (13) Google Scholar Conservative treatment is the rule, except when complications have occurred,4Sales M.J. Frise P. Roux F.X. Caumon C. Orbital varices: apropos of a case.Bull Soc Ophtalmol Fr. 1989; 89: 1287-1291PubMed Google Scholar as surgery can be complicated and hazardous. It is important to consider the more unusual and occasionally more serious differential diagnoses of painful red eyes in children with systemic disease. The atypical presentation in our case may have delayed diagnosis. On clinical suspicion of a retrobulbar mass, ophthalmologic review and imaging should be obtained immediately.

Magnetic resonance venography findings in orbital varix

In this report, we describe fast contrast-enhanced magnetic resonance venography (CE-MRV) findings in orbital varix. Although 2D-TOF MR angiography may allow the demonstration of low flow in venous vascular structures, orbital varices may not be detected as they contain stagnant blood and appear as soft tissue masses. The CE-MRV is faster, which allow to the Valsalva maneuver and can demonstrate stagnant blood with contrast enhancement. To the best of our knowledge, findings of CE-MRV in orbital varix has not been previously reported.

Orbital varices, cranial defects, and encephaloceles: An unrecognized association

Purpose To highlight an apparently unreported association between orbital varices and malformations of the cranial skeleton with or without abnormalities of the underlying cerebral parenchyma. Design Retrospective, noncomparative review of case notes and radiologic imaging. Participants Three hundred ten patients attending the Orbital Clinic at Moorfields Eye Hospital, London, with a diagnosis of low-pressure, low-flow orbital venous anomalies. Methods All available orbital imaging for patients with orbital venous anomalies was examined. For those with defects of the cranial base, the radiologic characteristics were noted and the clinical details were reviewed. Main outcome measures The presence and type of orbital roof or medial wall defects and associated nasal or other cranial anomalies. Results Imaging was adequate for review in 222 of 310 patients (72%), and anomalies of the neighboring cranium or cerebral structure were found in 10 of 222 patients (4.5%). In the group with cranial anomalies, the proportion of men (7/10; 70%) did not significantly differ from that in the group with varices but without cranial anomalies (93/212; 44%; P = 0.19, Fisher exact test). Orbital varices were associated with 3 types of cranial anomaly: major midline encephaloceles (type I anomaly; 4 cases), large superomedial defects of the orbital wall (type II; 3 cases), or defects of the greater wing of the sphenoid (type III; 3 cases). Conclusions Clinicians should be aware of the possibility of significant cranio-orbital or cranionasal anomalies in patients with orbital venous anomalies; these anomalies can vary from minor defects in the cranial base to large encephalomeningoceles. This rare association should not be overlooked when orbital varices become markedly inflamed, because intranasal encephaloceles are a known predisposition to recurrent meningitis.

Orbital varix rupture during cataract surgery

We report a case of orbital varix rupture during cataract surgery with retrobulbar anesthesia. No remarkable changes were observed 10 minutes after retrobulbar anesthesia was administered, but a rise in intraocular and intraorbital pressure was noted about 10 minutes after phacoemulsification began. The eyelid could not be closed at the end of surgery because of severe proptosis. Follow-up by magnetic resonance imaging and color Doppler imaging revealed orbital hemorrhage and varix. Based on the time of its appearance, the hemorrhage was thought to be the result of venous congestion caused by anesthetic agent in the muscle cone. Although intermittent exophthalmos is a symptom of orbital varix, silent orbital varix should be considered when selecting the method of anesthesia for ocular surgery.

Thrombosed orbital varix – a correlation between imaging studies and histopathology

A thrombosed varix in the orbit is comparatively rare. Clinical examination alone is often inadequate for diagnosis. Radio-logical examination, such as a computed tomography (CT) scan of the orbit, is extremely important. Histopathological examination (HPE) after excision biopsy can confirm the diagnosis. The present authors describe a case of proptosis in the left eye of a 45-year-old man. CT-scan and HPE supported the diagnosis of a thrombosed orbital varix. This paper discusses the use of radiological investigations to supplement a clinical suspicion and make the diagnosis. This entity needs to be included in the differential diagnosis of proptosis and requires a coordinated approach for establishment of the diagnosis.

Advances in imaging in oculoplastics.

Color Doppler imaging, computed tomography (CT) and magnetic resonance (MR) imaging are the most precious imaging tools for the clinician in the field of oculoplastics. Orbital and facial vasculature, with its dynamic changes and flow velocities seen in orbital varices, carotid-cavernous fistulas, and dural cavernous arteriovenous malformations, is best detected by Color Doppler imaging. Computed tomography remains the dominant imaging modality in the evaluation of orbital trauma. Helical CT axial scanning with multiplanar reconstruction and three-dimensional CT imaging are most helpful in assessing iatrogenic, traumatogenic, and teratogenic orbital abnormalities. Despite its poor histologic specificity, MR imaging provides superior soft tissue contrast, and contrast-enhanced MR imaging has an established role regarding soft tissue tumor infiltration. The greatest value of MR studies in the evaluation of orbital and palpebral tumors is that it has the capacity to show the precise relation between lesions and adjacent structures before the clinician contemplates a surgical approach. Finally, contrast-enhanced MR imaging proved to be a valuable vascularization indicator based upon the extent of relative enhancement within porous orbital implant in anophthalmic socket.

Orbital varices: imaging findings and the role of color Doppler sonography in the diagnosis

The orbital varices are infrequent intraorbital masses, which cause intermittent, positional exophthalmos. They have low venous pressure inside which causes difficulties in detection by routine protocols of nearly all imaging modalities. Color Doppler sonography is a simple procedure that can easily detect orbital varices which avoids further evaluation in non-complicated patients. We report the imaging findings of a case of orbital varix and discuss the role of color Doppler sonography in the diagnosis and follow-up.

Embolisation of Orbital Varix via the Superficial Temporal Vein

A case of orbital varix is presented, in which the lesion was successfully treated by means of embolisation with Guglielmi detachable coils, via the superficial temporal vein. Reports of endovascular treatment via transvenous route of orbital varix are lacking, only one case having previously been presented in the literature.We stress endovascular management for such an entity.

Congenital orbital varices causing extreme neonatal proptosis

PURPOSE: To report a 6-week-old male with extreme proptosis caused by thrombosed orbital varices. METHODS: A 6-week-old male presented with advanced proptosis of his left eye. Computed tomography and magnetic resonance imaging studies of the orbits revealed a heterogeneous cystic mass that filled the entire left orbit. Extreme proptosis and corneal exposure prompted urgent surgical excision of the mass. Histopathologic review of the lesion was consistent with orbital varices. CONCLUSIONS: Although orbital varices usually are found in adults, they should be considered in the differential diagnosis of orbital lesions in children. Observation is usually warranted, but surgical intervention may be necessary in advanced cases.

Orbital Lesions in the Blue Rubber Bleb Nevus Syndrome

Purpose: To identify ophthalmologic manifestations of the blue rubber bleb nevus syndrome, a rare cutaneovisceral hemangiomatosis.Methods: The authors report two patients with a diagnosis of blue rubber bleb nevus syndrome with orbital hemangiomas.Results: In one patient, the orbital lesion presented with signs and symptoms similar to an orbital varix and in the other with lid ecchymosis from an eyelid lesion.Conclusion: Patients with the blue rubber bleb nevus syndrome may have vascular orbital lesions associated with intermittent proptosis. Ophthalmologists should be familiar with the syndrome and its life-threatening complication of gastrointestinal hemorrhage.

Inferior ophthalmic vein varix and thrombosis

Orbital varices are congenital venous malformations of the orbit, affected by changes in venous pressure. Sudden thrombosis is an occasional feature of orbital varices. A case is presented of a patient with an inferior ophthalmic vein varix, in whom thrombosis developed five months after the initial examination, which regressed spontaneously during a follow-up period of six months. The literature is reviewed.

Orbital Varix Presenting as a Subconjunctival Mass

A 39-year-old woman presented with a vermiform superior conjunctival mass that progressively enlarged during 4 years of follow-up. Although magnetic resonance imaging suggested that the lesion was located in the superior forniceal conjunctiva, surgical exploration disclosed a vascular anomaly (varix) that extended deep into the orbit. The clinical features and management of orbital varices are discussed.

Orbital varices: a tricky diagnosis in MRI

Orbital varix (OV) is a rare condition causing intermittent positional exophthalmos. Because of low venous pressure, OVs tend to collapse, being frequently undetectable in routine CT or MRI examinations. We describe one case of giant intraorbital varix studied with CT and MRI techniques.