|Year : 1963 | Volume
| Issue : 3 | Page : 82-83
SP Srivastava, SC Jain
Department of Ophthalmology, G. R. Medical College, Gwalior, India
|Date of Web Publication||28-Jan-2008|
S P Srivastava
Department of Ophthalmology, G. R. Medical College, Gwalior
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Srivastava S P, Jain S C. Orbital varix. Indian J Ophthalmol 1963;11:82-3
Orbital varix has always aroused a great deal of interest in ophthalmic literature, resulting as it does in intermittent proptosis alternating with enophthalmos.
The condition is however rare and with few exceptions, all observers have seen but a single case (Duke Elder, 1952 a) being the cause in 90 per cent of cases of intermittent proptosis (Duke-Elder, 1952 b). Birsch Hirschfeld (1930) saw only one among 150,000 patients with ophthalmic disease. Walsh & Dandy (194.4) have brought the total of reported cases to III.
| Case Report|| |
A Hindu, female patient, aged 35 years, was admitted to the ophthalmic ward of J. A. Group of Hospitals. Gwalior, with a complaint of forward protrusion of the left eyeball on stooping down, for the last 5 years and pain associated with the proptosis for 2 years. There was no history of any trauma or of varicosities anywhere else in the body. The past history and the family history were without any significance.
The patient was of average build and well nourished. There was no evidence of varicose veins anywhere else in the body.
Local Examination. The left eye showed a distinct enophthalmos with slight widening of the palpebral aperture as compared with the right eye. The superior palpebral furrow was very deep [Figure - 1]. The lids, conjunctiva, cornea, pupil, iris, lens and the tension were normal. The movements of the eyeball were free and equal in all directions. Vision was 6/9. The fundus examination did not reveal any abnormality. The patient was able to produce proptosis of the left at will, at any time, just by stooping down for a few minutes. Proptosis was also induced when the patient coughed forcefully for sometime, or lay on the left side. Very little change was seen on compressing the external juglar vein. Forward protrusion of the eyeball started within a few seconds of stooping down and reached its maximum in about 2 minutes. At that time the eyelids and conjunctiva became suffused with a slight prominence of conjunctival blood vessels. The superior palpebral furrow which was very deep in the erect posture, was completely obliterated. [Figure - 2]. There was no pulsation or thrill palpable, after the production of proptosis. No murmur was heard on auscultation. The fundus examination at this time showed slight dilatation of left retinal veins. There was no change in the size of the pupil.
As soon as the patient assumed the erect posture the proptosis disappeared, the left eye assuming its previous enophthalmic position.
Right eye was normal, with vision of 6/6. Fundus was normal.
Investigations:- X-Ray examination of the skull, orbits and the sinuses, chest and neck did not reveal any abnormality.
| Comments|| |
The production of intermittent proptosis at will just by stooping down and its complete resolution on assuming the erect posture, the absence of any pulsation or thrill, there being no history of trauma, shows that the cause of intermittent proptosis was an orbital varix. The enophthalmos seen in this case on adopting the erect posture has been explained by pressure atrophy of the orbital tissues and retrobulbar fat resulting from recurrent attacks (Duke-Elder, 1952). The reduction in the size of the palpebral aperture during proptosis appears to be purely mechanical due to suffusion of the conjunctiva and eyelids as a result of venous stasis. The view expressed by Walsh (1957) that it can be attributed to an involuntary effort to favourably influence the amount of proptosis does not seem to be a probable explanation of the narrowing of the palpebral aperture in this case.
| Summary|| |
A case of intermittent proptosis which could be produced at will by stooping down and spontaneous regression on erect posture is presented. The cause is evidently an orbital varix.
| References|| |
Birch-Hirschfeld (1930), Cited by Walsh, Clinical Neuro-Ophthalmology II ed. (1957), Baltimore, p. 846.
Duke-Elder S. (1952a) Text book of Ophthalmology Vol. V. Henry Kimpton London, p. 5397. - - (1952b) Ibid_ p. 5627. - - (1952c) Ibid. P. 5401.
Walsh F. B. (1957), Clinical Neuro-Ophthalmology II ed. William & Wilkins, Baltimore, p. 847.
Walsh and Dandy (1944) Arch. of Ophth. 32, 1-10.
[Figure - 1], [Figure - 2]