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Cerebrospinal Fluid Leak Presenting as Oculorrhea After Blunt Orbitocranial Trauma

Apkarian, Alexandra O. MD; Hervey-Jumper, Shawn L. MD; Trobe, Jonathan D. MD

doi: 10.1097/WNO.0000000000000099
Clinical Observation

Abstract: Cerebrospinal fluid (CSF) leak is an uncommon but well-documented occurrence after blunt head trauma, typically manifesting as otorrhea or rhinorrhea. Blunt cranio-orbital trauma also may cause CSF leak into the orbit, manifesting as orbitocele, blepharocele, chemosis, or tearing (“oculorrhea”). We report a patient who developed oculorrhea after blunt head trauma, and neuroimaging disclosed comminuted fractures of the left frontal, greater sphenoid wing, nasal, and maxillary bones. Because he also displayed chemosis and markedly reduced ocular ductions and periocular pain, carotid-cavernous fistula was suspected but appropriate vascular imaging was negative. Aspiration of subconjunctival fluid was positive for beta-2 transferrin, a specific marker for CSF. Chemosis lessened and the oculorrhea ceased spontaneously within 6 days of the trauma. This manifestation of CSF leak must not be overlooked because of the threat of meningitis.

Departments of Ophthalmology and Visual Sciences (AOA, JDT), Neurosurgery (SLH-J, JDT), and Neurology (JDT), University of Michigan Kellogg Eye Center, Ann Arbor, Michigan.

Address correspondence to Jonathan D. Trobe, MD, University of Michigan Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI 48105; E-mail:

The authors report no conflicts of interest.

© 2014 by North American Neuro-Ophthalmology Society