Spontaneous Carotid Cavernous Fistula Presenting With Acute Angle Closure Glaucoma

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Abstract

Spontaneous CCSFs are usually related to abnormal communications between dural branches of the internal and external carotid arteries and the cavernous sinus. Ocular manifestations result from transmission of elevated venous pressure from the cavernous sinus to the orbit via the superior ophthalmic vein and its tributaries. Dilated episcleral and conjunctival vessels, proptosis, and increased IOP due to elevated episcleral venous pressure are characteristic findings. Venous stasis within the vortex veins leading to choroidal transudation is the proposed mechanism of choroidal detachment in CCSFs. We speculate that fragile, engorged long posterior ciliary veins may have ruptured during the evolution of a choroidal detachment and resulted in the suprachoroidal hemorrhage. Choroidal detachments may anteriorly rotate the ciliary body, shallowing the anterior chamber. In this patient, further angle closure was prevented by drainage of the suprachoroidal space. Spontaneous CCSFs often present characteristically, although the clinical appearance of low-flow fistulas may be subtle. Choroidal detachment and secondary angle closure are uncommon findings, but may be explained by the underlying hemodynamic abnormality.

Original languageEnglish (US)
Pages (from-to)596-597
Number of pages2
JournalArchives of ophthalmology
Volume107
Issue number4
DOIs
StatePublished - Apr 1989
Externally publishedYes

ASJC Scopus subject areas

  • Ophthalmology

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