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July 07, 2009; 73 (1) Resident and Fellow Section

Teaching Video NeuroImages: Positional exophthalmos in orbital varices

K. -D. Choi, H. -S. Lee, J. -W. Bae, H. Y. Choi, H. -J. Kim
First published June 29, 2009, DOI: https://doi.org/10.1212/WNL.0b013e3181aae827
K. -D. Choi
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H. -S. Lee
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J. -W. Bae
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H. Y. Choi
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H. -J. Kim
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Teaching Video NeuroImages: Positional exophthalmos in orbital varices
K. -D. Choi, H. -S. Lee, J. -W. Bae, H. Y. Choi, H. -J. Kim
Neurology Jul 2009, 73 (1) e8; DOI: 10.1212/WNL.0b013e3181aae827

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A 56-year-old woman presented with intermittent vertical diplopia and exophthalmos of the left eye, which become apparent when she was bending over. Examination disclosed mild limitation of supraduction and lid lag of the left eye. Bending over induced profound exophthalmos of the left eye (video) and aggravated vertical diplopia. The exophthalmos was confirmed by an exophthalmometer, which showed 16 mm right eye/15 mm left eye in the supine position, and 16 mm right eye/19 mm left eye in the prone position. Orbital MRI demonstrated enhancing lesions in the left retrobulbar area in the supine position (figure, A), which became prominent in the prone position (figure, B).

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Figure Gadolinium-enhanced axial MRI of the orbit in the supine position shows enhancing lesions in the left retrobulbar area (A), which become prominent in the prone position (B, arrowhead); accompanying exophthalmos of the left eye is also shown (B, arrow)

Orbital varices are congenital vascular abnormalities with the presentation of intermittent, positional exophthalmos due to the constraint of the venous return by certain head postures.1

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    Disclosure: The authors report no disclosures.

REFERENCE

  1. ↵
    Secil M, Soylev M, Ada E, Saatci AO. Orbital varices: imaging findings and the role of color Doppler sonography in the diagnosis. Comput Med Imaging Graph 2001;25:243–247.
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