Orbital varices

Description

Blood from the eye is usually drained by the superior and inferior ophthalmic veins which both drain into the cavernous sinus, with the central retinal vein draining into the superior ophthalmic vein.¹ Orbital varices are dilatations of the veins draining the eye causing proptosis, due to engorgement of the vessels, which can lead to haemorrhage, thrombosis and orbital nerve compression.² Treatment is usually conservative but there are surgical options, such as embolisation or laser surgery that can be used if symptoms are present.³ In this case, we see a 42-year-old man who presented with pressure behind the eye and swelling, especially if he bends over, and a blurring of vision. He was otherwise fit and well. On examination he was asked to perform a Valsalva manoeuvre (figure 1) which caused proptosis of his left eye—4 mm measured by exophthalmometer and he was diagnosed with an orbital varix. An MRI (figure 2) was booked and it showed the pooling of blood in the retrobulbar vessels and he is to be followed up in September in another hospital where they will decide whether to proceed conservatively or with bleomycin injection as he is not too troubled by the condition.

Figure 1.

The patient at rest (left) and performing the Valsalva manoeuvre (right)—showing proptosis of the left eye.

Figure 2.

MRI showing engorgement of the retrobulbar vessels of the left eye.

Patient’s perspective.

The feeling of pressure does not cause me much discomfort or hinder me in my day to day activities. However, it is noticeable and if I was given the choice I would opt for surgery as it definitive and would give me permanent relief.

Learning points.

• Patients typically present with unilateral (rarely bilateral) proptosis due to increased venous pressure.

• Usually treated conservatively but can be treated surgically if sight is affected and/or is causing the patient discomfort.