Orbital Varix
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A 63-year-old man was referred to our clinic with a 13-year history of intermittent vision loss, binocular diplopia, and blepharoptosis of the left eye during bending or straining that had worsened over the previous year. Other than uneventful cataract surgery, the patient had no clinically significant ocular history, and prior computed tomographic (CT) scans of the head and orbit did not identify any abnormality. An orbital vascular anomaly was suspected. A CT scan of the head was obtained while the patient performed the Valsalva maneuver, revealing the expansile orbital mass. On presentation to us, the patient's visual acuity was 20/20 in the right eye and 20/50 in the left eye, with a relative afferent pupillary defect in the left eye. There was no proptosis on examination (Panel A). Visual field testing revealed severe constriction. A Valsalva maneuver induced 6 mm of proptosis in the left eye, with anterior superior globe displacement and blepharoptosis (Panel B). Proptosis quickly reversed on relaxation. CT of the orbit, while the patient was at rest, was unremarkable (Panels C and D), but a Valsalva maneuver revealed an orbital mass causing anterior superior globe displacement (Panels E and F). An orbital angiogram confirmed the presence of an expansile orbital mass...

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