Dr. Divya Jain, J17996, Dr. Gopal Krushna Das, Dr. Pramod Kumar Sahu, Dr. Priyanka Dahiya
A 25 years old male presented with acute gross diminution of vision in Right eye with severe pain, watering for 7 days with grossly swollen lids. Patient had suffered from head injury 1 month back after falling from height.He had recovered completely with BCVA 6/6. NCCT Head at that time had shown fracture of sphenoid and ethmoid bone.No active neurological intervention done.On presentation visual acuity was I/60 in RE,severe proptosis,tense swollen lids,restricted extraocular movements,sluggish pupillary reaction,dilated vessels on fundus examination. Rest of the anterior and posterior segment was WNL. Patient started on intravenous antibiotics, topical antibiotics and cycloplegic medications but no improvement observed. Routine blood investigations and systemic evaluation revealed no abnormality. CECT Head and Orbit showed fracture in the body of sphenoid bone,dilated ophthalmic and facial veins suggestive of AV fistula. Angiography revealed a high flow Carotid Cavernous Fistula.