Ophthalmological presentation of carotid cavernous fistulas: case series and a paradigmatic case report

The purpose of this paper is to describe the clinical presentation of carotid cavernous fistulas (CCFs) managed in Hospital Egas Moniz between January 2010 and December 2020. Patients presenting with orbital congestive signs or symptoms with an ophthalmological evaluation and a diagnosis of CCF confirmed by digital subtraction angiography were included retrospectively. Carotid cavernous fistulas are rare and difficult to diagnose. Direct CCFs tend to have a more severe, acute onset presentation, while indirect CCFs are associated with a more insidious onset and chronic course. Anterior and inferior drainages are the most common in both direct and indirect CCF. Clinical presentation can be varied and nonspecific; however, patients commonly present with ophthalmological manifestations. All of our case series patients presented with ophthalmological complaints. The most frequently seen signs or symptoms were red eye (n = 8), increased intraocular pressure (IOP) (n = 8), and ophthalmoparesis with diplopia (n = 7)