VENOUS STASIS ORBITOPATHY - A CLINICAL AND ECHOGRAPHIC STUDY

Aims-A variety of acute and chronic orbitopathies may be distinguished by standardised echography. Venous stasis orbitopathy (VSO) often pre sents with orbital signs when secondary to cavernous sinus and middle cranial fossa disorders. In this study, the aim was to assess whether differentiation between vascular and nonvascular causes of VSO could b e made on the basis of clinical and echographic features at the time o f presentation. Methods-This study comprised 37 patients with echograp hic features of VSO (17 patients with arteriovenous fistulae, confirme d by computed tomography imaging or angiography, and 20 patients with non-vascular diseases). Excluded were patients with orbital mass lesio ns detected by echography and muscle enlargement due to other causes ( for example, orbital myositis). Patients with a suspected mass involvi ng the orbital apex and echographic features of VSO were included. Aft er full neuro-ophthalmic and ocular examination, both orbits were exam ined to document maximal thickness and reflectivity of four recti musc les and compared with the normal contralateral orbit with standardised A-scan (Kretz-technik 7200MA or Ophthascan) and contact B-scan (Ultra scan or Ophthascan S). Results-Cumulative ocular recti muscle thicknes s was significantly greater in patients with arteriovenous fistulae co mpared with the non-fistula group (23.3 (SD 3.7) and 17.8 (2) mm, p=0. 001). Clinically, the presence of a bruit and a uniocular rise in intr aocular pressure were significantly greater in the fistula group of pa tients. Conclusions-Standardised echography is a safe and non-invasive method of diagnosing VSO in patients presenting with signs of proptos is, ophthalmoplegia, and inflammation of the conjunctiva. Furthermore, using these standard techniques the two major causes of VSO (arteriov enous fistulae and compressive mass lesions) could be differentiated.