Features of differential diagnosis of direct carotid-cavernous fistula. Clinical case

Traumatic brain injury can cause various pathological conditions both in the eyeball and in the cranial cavity. The presented clinical case demonstrates the features of differential diagnosis of direct carotid-cavernous fistula and secondary post-traumatic glaucoma. Direct carotid-cavernous fistula is the formation of a communication between the internal carotid artery and the cavernous sinus and the discharge of arterial blood into it. The first symptom of a carotid-cavernous fistula is a pulsating noise in the head and above the eye. The manifest signs in the clinical picture are the signs of obstruction of venous outflow from the eye and the orbit: proptosis, eyelid edema and chemosis, congestive redness of the eye, varicose subcutaneous veins of the eyelids, as well as dilated ophthalmic vein visualized by ultrasound of the orbit, ophthalmic hypertension, oculomotor disorders, state of the fundus. The clinical picture in patients with secondary post-traumatic contusion glaucoma, in addition to an increase in intraocular pressure, is characterized by the presence of a congestive redness of the eye, changes in the cornea from mild superficial opacities to more dense ones, luxation or subluxation of the lens into the anterior chamber or vitreous, destruction of the vitreous or intraocular hemorrhage. The similarity of clinical manifestations of traumatic carotid-cavernous fistula and secondary post-traumatic glaucoma can cause difficulties in differential diagnosis.