Direct Communication Between the Ophthalmic Artery and Superior Ophthalmic Vein
A 37-year-old male patient presented with painless right eyelid edema that had begun 3 weeks prior. Intraocular pressure increased, and partial vessel engorgement was observed in the conjunctiva. Limitations of upgaze and lateral gaze in the OD were noted, and proptosis was observed. Superior ophthalmic vein (SOV) engorgement was identified on CT scan (Fig. 1A). A cavernous carotid fistula in the OD was suspected and referred to the neurosurgery department for embolization. Angiography revealed fistula of right ophthalmic artery and SOV. Approaching through the right femoral vein for embolization of the right SOV was unsuccessful, transvenous embolization via direct SOV approach was planned. The incision under the eyebrows ranging from 6 to 8 mm from the superior sulcus of the eyelid nasally. The orbital septum was opened, exposing the retroseptal orbital fat. Blunt dissection was carried down just lateral to the trochlear between medial and central fat pad and the SOV extending between the preaponeurotic fat was identified (Fig. 1B). Confirming fistula of right ophthalmic artery and SOV on angiography (Fig. 1C), embolization was performed. Eyelid swelling, exophthalmos, and extraocular movement limitations were recovered after the procedure. Direct communication between the ophthalmic artery and SOV is rare and transvenous embolization via direct SOV can be a good treatment option.Copyright © 2022 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.