Fact-sheet: Varix of orbit


Updated on 08/25/2020 at 5:11 PM

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Definition

Congenital venous malformation, located in the retrobulbar extraconal space.

Clinical features

  • Intermittent exophthalmos
  • Increased with maneuvers causing elevated venous pressure (Valsalva, head-down position)
  • Pain in case of thrombosis

Ultrasound

  • Doppler: slow to-and-fro flow
  • No distinct individualized lesion, the lesional area being hypoechoic relative to the adjacent orbital fat.

CT

  • Well-defined hypodense orbital mass
  • Calcifications (phleboliths)
  • Spontaneous hyperdensity in case of thrombosis
  • After injection: enhancement

Prone positioning sometimes required.

MRI

Patient positioned prone with head flexed downward, to simulate a Valsalva maneuver

  • Fat-saturated sequence to suppress orbital fat.
  • T1: hypointense
  • T2: hyperintense, variable depending on flow velocity
  • Gadolinium injection: enhancement.

Vascular intervention

  • Venous embolization if symptomatic

Management

  • Gamma Knife treatment possible

Differential diagnosis

  • Optic nerve sheath meningioma