Thrombosed orbital varix with mild, spontaneously resolving symptoms

Orbital varices are abnormally enlarged, thin walled veins in direct connection with normal orbital vessels. Stooping, bending, coughing or straining increase the venous tension and in this way can cause symptoms, such as bulging of the eyes (proptosis), orbital pain, bleeding, intermittent double vision. Small varices are managed by observation while larger lesions may require surgery. In our case report we demonstrate the case of a 72-year-old female patient with right sided retro-orbital pressure sensation for weeks, and exophthalmos with blurred vision for 1 week. MR investigation proved the presence of a partially thrombosed orbital varix on the right side, and a smaller, non-thrombosed varix on the left side. Observation was agreed, and the symptoms resolved spontaneously after several weeks.

Orbital Cellular Epithelioid Hemangioma

Purpose: To report a case of orbital cellular epithelioid hemangioma (EH) in which FOSB and CAMTA1 immunostains were used to detect a cytogenetic rearrangement as an adjunctive tool in diagnosis. Methods: Case report. Results: A patient with a history of prior ligation of a presumed orbital varix presented with recurrent proptosis. Imaging revealed a highly vascular right orbital mass. Microscopic examination revealed a circumscribed neoplasm composed of plump epithelioid endothelial cells with copious mildly eosinophilic cytoplasm and relatively uniform vesicular nuclei. To aid in diagnosis, immunostains for FOSB and CAMTA1 were performed to detect corresponding cytogenetic rearrangements. The presence of multifocal nuclear positivity for FOSB, indicating FOSB genetic rearrangement, and negativity for CAMTA1 were considered reassuring features against a diagnosis of a malignant epithelioid hemangioendothelioma (EHE), supporting a diagnosis of benign cellular EH. Conclusions: This case report demonstrates that the use of immunohistochemical stains to detect cytogenetic rearrangements may aid in the distinction between benign EH and malignant EHE. It also reminds providers of the clinical and histopathologic features of this lesion, which occurs rarely in the orbit, and helps clarify the evolving nomenclature surrounding epithelioid hemangioma.

Orbital varix

In the article, we report on pathogenesis, clinical features, and methods of diagnosis and treatment of orbital varix. (For citation: Potemkin VV, Ageeva EV. Orbital varix. Ophthalmology Journal. 2017;10(4):61-63. doi: 10.17816/OV10461-63).

Inferior petrosal sinus route microcatheterization study and embolization for primary orbital varix

Purpose Primary orbital varix is a rare lesion but difficult to treat. Our main aim was to demonstrate the varices and their central venous communication and to explore the feasibility of embolization of these lesions. Method In four patients with clinical suspicion of varix, in whom MRI showed retro-global vascular channels, microcatheter digital subtraction angiography (DSA) of the varices was performed using femoral venous access. Embolization was carried out in two patients. Results In all four patients orbital varices could be accessed with a microcatheter through inferior petrosal sinus and ophthalmic vein (superior or inferior) route. Microcatheter angiography showed opacification of varices and demonstrated their central venous communication. Two patients were treated with coil embolization. Complete resolution of symptoms was seen in one patient and partial relief in the other. Conclusion The study presents microcatheterization of orbital varices via the inferior petrosal sinus–cavernous sinus–ophthalmic vein route with injections into distal ophthalmic veins for demonstration of these variceal sacs and their central venous connection. Coiling to disconnect the venous communication should be the primary goal of embolization.

Republished: Transvenous sclerotherapy of a large symptomatic orbital venous varix using a microcatheter balloon and bleomycin

An orbital venous varix is rare and can present with diplopia, proptosis, or hemorrhage. Treatment can be challenging, especially if the varix is in a posterior location within the orbit, since surgical exposure becomes difficult. A few case reports have been published describing transcatheter embolization of an orbital varix with coils, direct percutaneous injection of n-butyl cyanoacrylate glue, and the percutaneous injection of bleomycin. We present a case of a symptomatic orbital venous varix of the left inferior ophthalmic vein successfully treated with transvenous endovascular sclerotherapy using a microcatheter balloon and bleomycin.