Orbital Varix (Varices)

Introduction:

What is an orbital varix?

An orbital varix is a thin walled vein enlarged abnormally in the orbit (bony socket surrounding the eye), that is in direct communication with the normal vessels of the orbit. It is like a varicose vein behind the eye. Orbital varices may be primary (congenital, most likely present from birth and restricted to the orbit) or secondary (acquired due to raised blood flow in relation with added venous deformations elsewhere in the body). Symptoms such as eye pain and/or orbital bleeding (hemorrhage) intermittent double vision (diplopia) or sudden onset bulging eyes (proptosis ), may be brought on by bending, stooping, straining or coughing. Small lesions are managed through observation. Larger lesions may need orbital surgery/ Orbitotomy.

Primary orbital varices are generally idiopathic. Secondary ones are those that are caused due to conditions such as intracranial arteriovenous malformations, dual arteriovenous fistula etc, which drain via the orbit.

Epidemiology:

Orbital varix, being a very uncommon condition, constitutes for approximately 1.3% of all orbital tumours. Though it is said to be congenital, and hence present at birth, patients classically do not present with symptoms until later childhood or until they have attained early adulthood (10-30 years of age).

Clinical Picture:

  • These type of lesions are classically associated with sudden onset, irregular diplopia (double vision) or bulging of eye forwards, during episodes of straining the eyes or stooping/prone position.
  • Due to protracted distension, more room for the eye may be created when not distended leading to posterior displacement of the eyeball (paradoxical enopthalmos), when the person is lying down or the orbit is at rest.
  • Orbital venous varices most commonly lead to intraorbital hemorrhage. These can also be acutely symptomatic & painful, if they get thrombosed. Such patients present with symptoms such as proptosis (forward displacement of the eye), pain in the eye & orbital region and diminished visual acuity.
  • Very rarely, lesions which are larger in size with involvement of superior ophthalmic vein can present as a mass in the lacrimal region.
  • Orbital venous varix is said to be associated with intracranial venous deformities, which may or may not have direct connection with the varix in some of the cases.

Diagnosis:

It can be very difficult or almost impossible to diagnose orbital varix without a procedure called

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