Caroticocavernous fistula

A patient with a right proptosis caused by caroticocavernous 

Arterialization of the episcleral vessels caused by
caroticocavernous fistula.
Caroticocavernous fistula typically causes unilateral proptosis with a red eye. However, no all proptosed eye with redness 
are caused by carotid cavernous fistula. The signs to look for in CCF are pulsation and arterialization of the episcleral 
vessels. Otherwise, conditions like thyroid eye disease, pseudotumour and cavernous haemangioma can also give rise to 
proptosis with engorged vessels (but no arterialization)

There is unilateral proptosis with arterialization of the episcleral vessels. The globe is pulsating on close observation. Bruit can be hear over the orbit (best with the bell of the stethoscope). In severe cases, there may be ophthalmoplegia due to orbital 

Mention you would like to examine:

  • the intraocular pressure
  • the anterior segment and posterior segment for signs of ischaemia (anterior uveitis, rubeosis iridis, cotton wool spots etc).


1. What are the different types of caroticocavernous fistula?

2. The following scan belongs to a patient who suffered from a right sided caroticocavernous fistula. What pathology can be seen here?


3. What are the treatment options for caroticocavernous fistula?

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