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Abstract
Introduction/Purpose An orbital varix is a rare pathology that has abnormally distensible, thin-walled veins, primarily caused by congenital venous malformation or secondarily by obstruction of orbital venous outflow. Most cases affect the superior or inferior ophthalmic vein unilaterally, with a range in severity of symptoms. We present a rare case of unilateral progressive proptosis caused by a secondary orbital varix due to thrombosis of the inferior ophthalmic vein.
Materials and Methods This study consists of a retrospective, single-center patient case report assessing the management and outcomes of a thrombosed orbital varix. Consent to publish this deidentified case report was obtained.
Results A 74-year-old male was admitted to the emergency department with a three-day history of progressive painful proptosis of the left eye. His medical history included hypertension and hyperlipidemia and no history of trauma. Clinical examination revealed a left proptotic orbit with chemosis and scleral injection. Visual acuity of the left eye was 20/150. The right eye was unremarkable; the patient was afebrile with no infectious signs. CT scan showed an ovoid mass in the lateral intraconal space with surrounding infiltration and increased vascularity. CT angiogram revealed a well-circumscribed heterogeneously enhancing mass within the inferior intraconal space of the left orbit (measuring 1.8 x 1.7 cm) with periorbital soft tissue swelling, suggesting inflammation (figure 1). MRI Angiogram confirmed these findings; orbital cellulitis was apparent, the left inferior ophthalmic vein was prominent as compared to the right, and there was a partly thrombosed venous varix of the inferior ophthalmic vein with no evidence of arteriovenous fistula. A decision for conservative treatment without intervention was reached, with aggressive interventions reserved only in the case of clinical deterioration. Five days of intravenous methylprednisolone was prescribed, as well as maintained oral corticosteroids, doxycycline, and levofloxacin. A two-week follow-up CT scan with contrast demonstrated a stable soft tissue intraconal mass in the left orbit with peripheral venous phase as well as central enhancement, consistent with the previously diagnosed thrombosed orbital varix. One year later, orbital MRI depicted a slight increase in the enhancing left intraconal mass.
Conclusion An orbital varix may present with mild to severe symptoms and, depending on case severity, treatment ranges from medical management to surgical intervention. Our case is one of few progressive unilateral proptosis caused by a thrombosed varix of the inferior ophthalmic vein described in the literature. We encourage further investigation into the causes and epidemiology of orbital varices.
Disclosures T. Eatz: None. A. Abdelsalam: None. I. Ramsay: None. U. Ehiemua: None. J. Thompson: None. H. Fountain: None. E. Wu: None. R. Bhatia: None. B. Lam: None. D. Tse: None. R. Starke: None.