Ocular Manifestations Of Carotid Cavernous Fistula and Clinical Outcome After Management

Abstract

Aim: The purpose of the study is to report the ocular manifestations of Carotid cavernous fistula. Toconfirm the diagnosis by radiological investigations and to evaluate the clinical outcome aftermanagement. Materials and Methods: Patients who presented to the ophthalmology departmentwith signs and symptoms of carotid-cavernous fistula were evaluated by clinical examinationfollowed by radiological investigations like ultrasound, Doppler, CT scan and MRI. They laterunderwent DSA ( Digital Subtraction Angiography) for confirmation followed by definitive treatment.Results: Out of four patients who had direct CCF, three cases were managed by endovascularembolization of the parent artery. The remaining one case was conservatively managed by carotidmassage as it was a low flow fistula and the patient also had Parkinson’s disease. Four cases thathad indirect CCF were managed by carotid massage. Complete closure of the fistula is seen in allcases. Patients were followed up for 1 month, 3 months and 6 months and clinical outcome wasevaluated. Conclusion: CCF should be suspected in the presence of arteriolised conjunctivalvessels, proptosis and audible bruit. Diagnosis is by radiological tests like ultrasonography, Doppler,CT scan and MRI. The confirmatory test is digital subtraction angiography (DSA). Direct CCF iseffectively treated with endovascular therapy by coiling the fistula and indirect CCF is managed bymanual compression. Early diagnosis and treatment can prevent sight-threatening complications.