Session: Poster session C

Intermittent strabismus secondary to orbital varicose vein.

Introduction

Orbital varicose veins are congenital or secondary venous anomalies, characterized by dilatation and proliferation of the orbital venous vessels. The most frequent clinical sign is intermittent exophthalmos.

 

Methods

We present the case and images of a 34-year-old female patient with left orbital varicose vein with clinical symptoms of intermittent enophthalmos and strabismus that appears depending on head position and Valsalva maneuvers.

 

Results

The patient presented with a left ET esotropia of 30 prism diopters (PD) without vertical strabismus with inferior and left lateral gaze limitation in the left eye since childhood. During Valsalva's maneuver or head tilt, a left upper hypertropia of 50 PD appeared with enophthalmos. 

Macroscopic examination showed a soft bluish lesion in the palpebral region of the left inferior orbital septum and also in the inferior conjunctival sac fundus.  Magnetic resonance imaging described a palpebral and orbital finding compatible with venous dilatation. 

 According to the literature, strabismus and enophthalmus are rare manifestations of orbital veins. One case of intermittent enophthalmos without strabismus caused by Valsalva maneuver has been reported. 

In our patient, the possible relationship between orbital vascular pathology and extrinsic ocular musculature could be the cause of strabismus and enophthalmos. 

 

 Conclusions.

Although exophthalmos is the most likely clinical symptom of orbital veins, strabismus and enophthalmos may also occur.