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This report illustrates a case of asymptomatic bilateral orbital varices in a 64-year-old Caucasian male. The orbital varices were incidentally discovered while investigating the patient's initial presentation of bilateral chorioretinal scars and optic nerve head drusen. Magnetic resonance imaging (MRI) of the brain and orbits with contrast confirmed the presence of bilateral varices of the inferior ophthalmic veins and pterygoid plexuses. The occurrence of bilateral orbital varices is quite rare, and few asymptomatic cases have been described in the literature.

Professor Sergei Semjonovic Golovin (1866-1931) is considered as one of the founders of ophthalmology in Russia. He received a worldwide reputation thanks to his achievements in ocular surgery and pathology. He introduced new surgical techniques such as Golovin’s operation (Exenteratio orbitosinualis), Golovin’s osteoplastic frontal sinus operation, ligation of orbital veins, and opticociliary neurectomy. He also introduced his “cytotoxic theory” to interpret sympathetic ophthalmia. He was a reputable professor of ophthalmology.

In this paper, we demonstrate a capability of surface coil magnetic resonance imaging in the review of orbital blood vessels anatomy. Surface coil allows a better detection of small anatomic structures including vessels such as ophtalmic artery and its branches, and also orbital veins, particularly superior and inferior ophtalmic veins with accompanying branches. The best results are obtained by the use of T1 sequences with short TE and TR.

Experience is given from 79 orbital lesions examined by Colour Doppler Flow Imaging (CDFI) Dec. 1990 to Febr. 1992. We further examined 167 ocular tumours, or tumour-like lesions, and 32 ophthalmic cases groups as 'various'. Here, our experience is summarized concerning the flow patterns demonstrated in orbital veins, pathologic and normal. Adding dynamic and quantitative information to the clinical evaluation CDFI proved superior to conventional B- and A-mode echography. The method is essential in assessing and establishing the diagnosis of low flow dural malformations of the cavernous sinus. Pulsed Doppler appears helpful for the decision of therapy (embolization) and its optimum timing.

The orbital venous system is complex, highly variable, and confusing. In the orbit, unlike other parts of the body, there is no direct correspondence between the arteries and veins, except for the superior ophthalmic vein which has some correspondence with the ophthalmic artery. Also, the orbital veins, unlike the orbital arteries, have a highly variable and inconstant pattern and formation of venous networks at several places, resulting in marked uncertainty and controversy as to their number, nomenclature, and pattern. The latest detailed studies on the orbital venous system are those of Henry [1] and Cheung and McNab [2].

The orbital veins develop from the primitive maxillary and supraorbital veins, tributaries of the cavernous sinus developed from the pro-otic sinus (see also embryology, Chap. 9). The final result of the embryological evolution of these venous channels is the superior and inferior ophthalmic veins, draining posteriorly in the cavernous sinus. They are connected anteriorly with the facial and frontal veins. Other connections are those with the pterygoid plexus (see also Sects. “Superior and Inferior Ophthalmic Veins” 9.3.11 and 9.3.12) (Drawing in Fig. 10.1).

We report on 8 patients with ‘dilated orbital veins’ seen over a 10-year period. Six were females aged 51–81 with carotico-cavernous fistula, three traumatic and three spontaneous. In five out of the six, retrobulbar dilated orbital veins could be typically demonstrated by ultrasound. The clinical features — among them a doctor’s delay — are given. The remaining two patients were males. One had an orbital varix behind the eye, the other a complex of enlarged orbital veins, with arterialized blood flow, along the medial orbital wall, presenting anteriorly as a soft tumour. The issue of dilated orbital veins is a rewarding field for ultrasound diagnosis.

Normal antero-posterior superior and inferior orbital veins are rarely seen during orbital examination. Sometimes, it is possible instead to show on the screen the vertical veins.

Post-traumatic thrombosis of cavernous sinus and orbital veins has been reported in conjunction with carotid-cavernous sinus fistula (CCSF). CCSF are abnormal communications between the carotid artery and the cavernous sinus. Spontaneous thrombosis of a CCSF is a rare event mainly seen in the indirect (dural) type of fistula. We report on a patient with a possible post-traumatic CSSF which underwent partial spontaneous thrombosis and presented with an extreme degree of proptosis.

The technique of venography is described for visualizing the orbital veins and the cavernous sinuses following cannulation of the angularis oculi vein and the subsequent injection of 10 ml sodium iothalamate. The venograms clearly demonstrated the veins of the orbit and cavernous sinuses in most of the animals. Two intercavernous sinuses, rostral and caudal, were visualized. In a few goats, transverse and dorsal longitudinal sinuses of the dorsal system of the dural sinuses were also visualized.

Under normal conditions no vessels in the orbit are detected with the presently available ultrasonography equipment. the authors reported a series of 41 patients in whom the superior ophthalmic vei...

The extent of changes in orbital veins depends primarily on the size of the space-occupying lesion. Large tumors, irrespective of their position, produced change in the orbital vein, but among small tumors only the superior and medial tumors produce slight changes in the orbital vein. Localization of the tumor is also an important factor. The superior tumors are characterized by the angle between the 2nd 3rd SOV segments not exceeding 100 degrees and by the quadrangle surface of 419 mm2 in average. The inferior tumors elicit slight changes in SOV. The medial tumors cause an increase of the angle between the 2nd and 3rd SOV segments above 130 degrees and the surface area of SOV quanrangle up to 550 mm2. The most characteristic feature of the intraconic tumors is the normal X point position. Shape of the tumor plays a minor role in producing changes in orbital veins.

Transfrontal orbital phlebography is a simple and safe procedure that, combined with computerized tomography and ultrasonography, can offer an indispensable diagnostic aid. the phlebographic picture will show the precise nature of the lesion, if this is venous. Moreover, it will detect a displacement of the superior orbital vein and the rate of drainage into the cavernous sinus. Typical phlebographic pictures are presented: sclerosis, thrombosis, varices, angiomatosis and venous angioma, endocrine proptosis, secondary displacements, etc.

Description of a 68-year-old woman with intermittent exophthalmus produced by valves in the orbital veins, which have not been described hitherto.

Orbital veins can easily be demonstrated by ultrasound when they are dilated. They appear as a non-echogenic defect in the orbital fat, linear or round, the shape depending on the orientation of the ultrasound plane. Thickening of the choroid is frequently associated with it. Such echographic pictures are to be distinguished from those of orbital varices and of rectus muscles. They are completely different from the pictures given by orbital hemangiomas.

A patient with amyloidosis in the right bulbar conjunctiva and conjunctival haemorrhagic lymphangiectasia is presented. An orbitophlebography revealed occlusion of the superior and inferior ophthalmic veins in both orbits. A biopsy from the left bulbar conjunctiva obtained at the same time revealed conjunctival haemorrhagic lymphangiectasia but no amyloid. The possible relationship of the findings is discussed.

In the reply to his critics G. Levinsohn 1 repeats his assertions that myopia is due to the effect of gravity in the bent forward position of the head. The eyeball is said to protrude in this posture and to assume a pearlike shape, being similar to a bag of water suspended from a hook, the optic disk being the punctum fixum. Indeed, the protrusion of the eyeball can be easily verified in many cases. However, this protrusion indicates a forward movement of the eyeball in toto and by no means an alteration of the shape of the eye. It is due to the congestion of the orbital veins. The extent of the protrusion depends on the size of the aperture between the lids, on the resistance of the orbital septum, ligaments, muscles and other structures and on the degree of filling of the orbital veins. If the protrusion were

Although the 47 chapters of these four books are not arranged alphabetically, they constitute an encyclopedia of angiography of the head (including the face and eye). The contributors from North America, Europe, Australia, and Japan have reported on their areas of special interest in detail. The inevitable repetition is welcome, and makes it unnecessary to move back and forth too much between different volumes. Book 1 is devoted to technical matters (how to do angiography, what materials to use, what complications occur, what views are best to take, etc). The use of serial angiography in the evaluation of cerebral hemodynamics, a historical introduction to angiography, and embryologic and developmental analysis lead into the second, thickest, volume, which begins with anatomy of the aortic arch and the brachiocephalic arteries. Each of the major vessels is described in detail complemented by diagrams, anatomical dissections, and angiograms. The orbital veins and cavernous sinus

Abnormal protrusion of the eyeball is encountered in a wide variety of both local and general conditions. This article is devoted to constitutional diseases in which exophthalmos appears as either a complication or a part of the general abnormality. A certain amount of overlapping exists, because much of the exophthalmos which is encountered in general disease depends on the local accumulation in the orbit of tumors, hematomas or other masses, on the production of stasis in the orbital veins or on edema of the orbital tissues, all of which may result in forward dislocation of the eyeball. This generalization at times applies to the exophthalmos of exophthalmic goiter, which will be considered presently. It is partly, often wholly, applicable to the exophthalmos that occurs occasionally in other constitutional abnormalities. EXOPHTHALMOS IN DISEASES OTHER THAN EXOPHTHALMIC GOITER Exophthalmos is rare in syphilis. Delord1described bilateral protrusion of the eyes