97th DOG Annual Meeting 1999



A. Lambert1, S. Scommotau1, F. Deckert2, K. Pittasch1

Introduction: Characteristical clinical symptoms of the carotid cavernous fistula are exophthalmus and pulsation of the globe, further orbital bruit and dilated episcleral vessels.We report about a case with extensive choroidal detachment as a leading symptome.

Case: A 84-year-old female patient admitted herself to the eye clinic because of pain and redness of the left eye. The visual acuity was 0.4. The patient was aphakic. She also remembered a fall onto her left temple. The intraocular pressure was in the normal range. No protrusion or pulsation of the globe was seen and a bruit was not registered. A circular bullous choroidal detachment was the most significant finding apart from congestion of the episcleral vessels and of the retinal veins with intraretinal hemorrhage. The choroidal detachment progressed and an angiogram was performed in January 26th, 1999. The angiogram showed a low flow cavernous sinus fistula, which was supplied from 3 branches of the external carotid artery. An embolisation was rejected by the patient. Because of progression of the choroidal detachment the visual acuity decreased to light perception.

Conclusion: The choroidal detachment, which was the most significant symptom of the carotid-cavernous fistula and the reason for the decreased visual acuity is rarely described in literature. When extensive choroidal detachments are registered, an arteriovenous fistula should be included in the differential diagnosis.

Department of Ophthalmology1, Department of Radiology2, University of Leipzig