Margarita G Todorova1, Cameron F Parsa. 1. Department of Ophthalmology (MGT), University of Basel, Basel, Switzerland; and Quinze-Vingts National Ophthalmology Hospital (CFP), UPMC-Sorbonne Universities, Paris, France.
Abstract
BACKGROUND: Variable pupillary responses have been described with carotid-cavernous sinus fistulas. These often are associated with a decrease in visual acuity and attributed to retinal ischemia. We propose a novel pathophysiologic mechanism for changes in pupillary reactivity involving anatomic changes secondary to choroidal effusion. METHODS: To demonstrate proof-of-concept, we investigated 2 consecutive patients with carotid-cavernous sinus fistulas and pupillary disturbances using repeated refractions and anterior segment ultrasound biomicroscopy. RESULTS: Ultrasound biomicroscopy demonstrated choroidal thickening and ciliary body effusion with forward rotation of the lens-iris diaphragm altering refraction and mechanically limiting iris movements. CONCLUSIONS: Where there are acute elevations in orbital venous pressure causing ciliary body effusion, changes in visual acuity and pupillary abnormalities can be produced by mechanical effects.
BACKGROUND: Variable pupillary responses have been described with carotid-cavernous sinus fistulas. These often are associated with a decrease in visual acuity and attributed to retinal ischemia. We propose a novel pathophysiologic mechanism for changes in pupillary reactivity involving anatomic changes secondary to choroidal effusion. METHODS: To demonstrate proof-of-concept, we investigated 2 consecutive patients with carotid-cavernous sinus fistulas and pupillary disturbances using repeated refractions and anterior segment ultrasound biomicroscopy. RESULTS: Ultrasound biomicroscopy demonstrated choroidal thickening and ciliary body effusion with forward rotation of the lens-iris diaphragm altering refraction and mechanically limiting iris movements. CONCLUSIONS: Where there are acute elevations in orbital venous pressure causing ciliary body effusion, changes in visual acuity and pupillary abnormalities can be produced by mechanical effects.
Authors: Joy Li; Jennifer Drechsler; Anna Lin; Matthew Widlus; Azam Qureshi; Gianna Stoleru; Osamah Saeedi; M Roni Levin; Mona Kaleem; Mohamad Jaafar; William P Madigan; Janet Leath Alexander Journal: Ultrasound Med Biol Date: 2021-04-13 Impact factor: 3.694