|Year : 1984 | Volume
| Issue : 4 | Page : 235-237
OP Kulshrestha, Indu Arora, Madhu Mathur, A Matai
Department of Ophthalmology, S.M S Medical College Jaipur, India
O P Kulshrestha
Professor Ophthalmology. S.M.S. Medical College, Jaipur (Raj)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kulshrestha O P, Arora I, Mathur M, Matai A. Orbital varices. Indian J Ophthalmol 1984;32:235-7
Venous varices are rare orbital lesions that cause a characteristic intermittent exophthalmos. Llyod has divided orbital varices into two types, the first being varices unassociated with an arterio-venous malformation within the orbit or in the cranium. These represent primary congenital venous malformations or mural weaknesses that are not secondary to arterialisation of the venous system.
The second major type of orbital varix is secondary to an intraorbital or intracranial arterio-venous communication. These angiomas are usually found in the middle cranial fossa with venous communication through the superior orbital fissure.
Wright has classified initial symptoms of orbital varices into five groups. (1) Variable proptosis, associated with dilated veins in the lids and episcleral tissue. (2) Dilated veins in the lid and anterior orbit (3) Variable proptosis without any visible lesions (4) Acute orbital haemorrhage (5) Acute thrombophlebitis.
In addition to these, venous varices may be associated with recurrent orbital pain, motility disturbances and diminished vision due to optic nerve involvement.
Walsh & Dandy observed that although the anomaly is most probably congenital in origin, the clinical signs may not become apparant until later in life, most cases presenting themselves in the first three decades.
| Case report|| |
This 35 year old male had greenish-black pigmentation over the right eye ball and the right lower lid since birth. This pigmentation had been increasing since three months before admission. Since that time he has also noticed a gradual bulging of the right eye and increasing puffiness and swelling over the right lower lid which increased slightly on exertion and on bending forwards.
There was no history of fever, vomiting, trauma or diplopia.
On examination there was a boggy swelling towards the medial side of the lower lid 3 cms x 3 cms with greenish-black discolouration over the skin and upper and lower fornices. The palpaberal aperture on the right side was reduced by 3 mm. [Figure - 1][Figure - 2].
The exophthalmic reading (by Hertel's exophthalmometer) was 22 mm RE and 17 mm LE. The proptosis was reducible to some extent but was not pulsatile. No bruit was heard over it. The corrected visual acuity was 6/6. Fundus showed normal disc arteries and macula.
Movements of the eye in the up and in direction were restricted.
An orbitovenogram on the right side was performed. The parallelogram which is formed by the three segments of the superior Ophthalmic vein (Offret and Anon-Rosa 4sub ) could not be seen, instead there was a jumble of dilated tortuous veins in the antero-lateral aspect of the orbit. [Figure - 3]
No bony defects or enlargement of the orbital fissures was observed.
| Discussion|| |
The presence of the greenish-black discolouration on the lids and the fornices of this patient since birth points to the presence of congenital capillary varices which later developed into venous varices producing proptosis and lid swelling when the patient was 35 yrs. old. This mode of presentation is also reported by Hobbs et al 5sub who feel that the lesion represents a vascular hamartoma which at birth may be seen either in a capillary form that is clinically quiescent or in a fully developed venous form. The quiescent capillary type then develops into a venous type of structure, either form developmental or haemodynamic causes and becomes clinically evident and produces intermittent exophthalmos at a later age, i.e. mostly in the first three decades.
This is a typical and rare case of venous varices of the anterior orbit involving the lids and episclera.
The non-pulsatile exophthalmos and absence of bruit negates the presence of an AV fistula. The normal sphenoidal fissure and normal bones of the orbit, point to the fact that this is a case of isolated venous varices without any arterial component and confined only to the orbit and lids.
Conservative treatment is of prime importance since meddlesome operative intervention may produce severe orbital haemorrhage, followed by proptosis, lagophthalmos and corneal ulceration. Radiotherapy and sclerosing agents are of no value (Troost and Glaser 6 ).
| Summary|| |
A case of congenital venous malformation of the orbit involving the episclera and lids, with no arterial communication and confined to the orbit alone, in a 35 year old male demonstrated by an orbito-venogram has been reported here.
| References|| |
Llyod G.A., Wright J.E., Morgan G., 1971, Br. J. Ophthalmol., 55:505.
Wright J.E., 1974, Trans. Am Acad. Ophthalmol. Otolaryngol., 78: 606.
Walsh W.B. and Dandy W.E., 1944, Trams. Amer. J. Ophthalmol. Soc., 42:334-354.
Offert and Anon-Rosa, 1967, In orbit and contrast media. Lombardi G. ed. Radiology in Neuro-Ophthalmology, Baltimore, The Williams and Wilkins Company 1967 pg. 12-13.
Hobbs, H.E.; Boculay G Du & Davies RE., 1960, Br. J. Ophthalmol., 44:551.
Troost B.T. and Glaser J.S., 1980, communications and related vascular malformations. In. Duane, T.D. ed. Clincial Ophthalmology, London, Harper & Row Pub. 1980, Vol. 2 Chap. 17, pg. 26-27.
[Figure - 1], [Figure - 2], [Figure - 3]