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Schultz H, Bacorn C, Cristiano BC, Carey AR, Carper MG, Gailloud P, Miller NR, Campbell AA. Bilateral Dilated Superior Ophthalmic Veins in a Patient With an Arteriovenous Dialysis Fistula. Ophthalmic Plast Reconstr Surg 2024; 40:e19-e23. [PMID: 37721308 DOI: 10.1097/iop.0000000000002524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
A 64-year-old man presented with 4 months of diplopia. He had end-stage renal disease requiring a cephalic transposition brachiocephalic fistula that was no longer in use following successful renal transplantation. On presentation, he had bilateral proptosis, extraocular movement restriction, chemosis, tortuous episcleral vessels, and caruncular injection. Non-contrast CT of the orbits demonstrated dilation of both superior ophthalmic veins, and CT angiography showed asymmetric enlargement of both cavernous sinuses and superior ophthalmic veins. A carotid-cavernous fistula was suspected, but cerebral angiography revealed shunting from the old fistula with intracranial drainage and cerebral venous hypertension. Aberrant retrograde drainage resulted from anatomical compression of the left brachiocephalic vein. The fistula was ligated, and at 1-week follow-up, the patient had marked improvement in extraocular movements and orbital congestion with near complete resolution of diplopia. Postoperative CT angiography obtained 2 months later demonstrated decreased size of both superior ophthalmic veins, consistent with improvement of venous hypertension.
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Affiliation(s)
- Hannah Schultz
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Colin Bacorn
- Division of Oculoplastic Surgery, Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Brian C Cristiano
- Department of Interventional Neuroradiology, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Andrew R Carey
- Department of Ophthalmology, Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Michael G Carper
- Department of Ophthalmology, Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Philippe Gailloud
- Department of Interventional Neuroradiology, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Neil R Miller
- Department of Ophthalmology, Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Ashley A Campbell
- Division of Oculoplastic Surgery, Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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Zahari KM, Mohamad Hatta NS, Ain Masnon N, Ch'ng LS. Central vein stenosis: a rare cause of orbital congestion in a haemodialysis patient. BMJ Case Rep 2023; 16:e254999. [PMID: 37643820 PMCID: PMC10465891 DOI: 10.1136/bcr-2023-254999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
We report a rare, potentially sight-threatening ocular complication due to central venous stenosis related to a previous site of haemodialysis catheter. A dialysis-dependent woman in her 60s presented with left eye redness for 1 month followed by a remarkably prominent vessel on the left upper eyelid for 2 weeks. Examinations found left eyelid oedema with prominent venous dilatation on the upper eyelid as well as left eye mild proptosis, conjunctiva injection with corkscrew vessels, raised intraocular pressure, and dilated and tortuous retina vessels. Central thoracic venogram showed total occlusion on the left brachiocephalic vein with retrograde reflux to the jugular vein. An endovascular percutaneous transluminal balloon angioplasty was performed for the left brachiocephalic vein stenosis, which resolved the orbital, facial and neck venous congestion. The patient remained asymptomatic after 1 year.
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Affiliation(s)
- Khalilah Mastura Zahari
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- Department of Ophthalmology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Nurul Ain Masnon
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Li Shyan Ch'ng
- Department of Radiology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- Department of Radiology, Faculty of Medicine, UiTM Sungai Buloh, Selangor, Malaysia
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Gómez-Arbeláez D, García-Gutiérrez A, González-Fajardo JA. Unilateral Proptosis (Exophthalmos) Caused by Axillary-Subclavian Venous Thrombosis in a Patient with Upper Extremity Arteriovenous Dialysis Fistula. Methodist Debakey Cardiovasc J 2021; 17:24-27. [PMID: 34824675 PMCID: PMC8588745 DOI: 10.14797/mdcvj.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/26/2021] [Indexed: 11/08/2022] Open
Abstract
Arterialization of orbital veins is most often due to dural arteriovenous malformations of the cavernous sinus area. We report an unusual case of unilateral proptosis (exophthalmos) caused by arterialized retrograde venous flow in the external jugular vein and cavernous sinus in a patient with an upper extremity hemodialysis fistula and ipsilateral acute central venous thrombosis. The patient’s symptoms improved after surgical closure of the hemodialysis fistula.
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