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A 54 year old woman with a red eye
Digital Journal of Ophthalmology 2004
Volume 10, Number 8
July 28, 2004
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Chris Hammond | Princess Royal Hospital
Gurmit Uppal | St Thomas Hospital
Saurabh Jain | St Thomas Hospital
Ancillary Testing
Radiographic Studies

She was booked for an urgent CT scan, which was performed the same day.
The scan showed enlarged muscles in the right eye but more significantly a very large right superior ophthalmic vein (Figure 4). Further history obtained at this stage revealed an episode of bifrontal headache and eye pain 4 months prior.

She was referred urgently to the neurosurgeons with a working diagnosis of a caroticocavernous fistula. Cerebral angiography confirmed the diagnosis by demonstrating a fistula fed by the meningio-hypophyseal branch of the left internal carotis artery and a branch from the left external carotid artery. Drainage appeard to be via the superior ophthalmic vein which appeared thrombosed.

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Figure 4
CT scan demonstrating enlargement of the right superior ophthalmic vein.