Pulsatile proptosis

• Usually caused by carotid-cavernous fistula which may occur after trauma (may also be due to intracavernous saccular aneurysm or Ehlers-Danlos) and cause arterial blood to get into the superior or inferior ophthalmic veins that empty into the sinus
• In addition to pulsatile proptosis may also get palsy of CN 6 (most common) or CN 3 or 4 less commonly, along with loss of vision
  • 5-10% of fistulas resolve spontaneously but most require an interventional radiologic means of occluding the carotid
  • CC fistulas may be occluded by either embolizing the feeding arteries or if the feeding vessels are too small, the cavernous sinus may be packed with coils
• other causes of exophthalmos: hyperthyroidism and ocular tumors (such as in neurofibromatosis)