Intraorbital arteriovenous fistula secondary to penetrating injury

Purpose: To describe the clinical and radiologic features and management of an intraorbital arteriovenous fistula secondary to penetrating injury. Method. Interventional case report and literature review. Results: We describe a 13-year-old girl with a history of penetrating orbital injury who presented with proptosis, eyelid hyperemia, and orbital venous congestion. Computed tomography showed a large foreign body in the superiormedial orbit and an enlarged superior ophthalmic vein (SOV). Doppler ultrasonography revealed arterialized flow in the SOV. Removal of the foreign body did not alter the orbital symptoms. Carotid angiography disclosed a fistula between the ophthalmic artery and the SOV. The patient underwent an attempted coil embolization of the fistula through the femoral vein, which was unsuccessful, but she developed profound thrombosis of the SOV, which propagated through the orbital venous system. Although orbital venous congestive symptoms were acutely exacerbated, they regressed spontaneously within I month. The patient was followed for 23 months without recurrence. Conclusions: Penetrating injury of the orbital apex may lead to the formation of an arteriovenous fistula, transvenous embolization of which may be complicated by thrombosis of the SOV. In our case, this unintentional result facilitated the resolution of the fistula.