Pulsatile Exophthalmos
Pulsatile exophthalmos due to traffic accident. Pulsatile exophthalmos or pulsatile proptosis is a clinical symptom characterized by protrusion and pulsation of the eyeball. In this case, the cause is carotid-cavernous fistula. A carotid-cavernous fistula (CCF) results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. It is a type of arteriovenous fistula. As arterial blood under high pressure enters the cavernous sinus, the normal venous return to the cavernous sinus is impeded and this causes engorgement of the draining veins, manifesting most dramatically as a sudden engorgement and redness of the eye of the same side. CCF symptoms include bruit (a humming sound within the skull due to high blood flow through the arteriovenous fistula), progressive visual loss, and pulsatile proptosis or progressive bulging of the eye due to dilatation of the veins draining the eye. Pain is the symptom that patients often find the most difficult to tolerate. Patients usually present with sudden or insidious onset of redness in one eye, associated with progressive proptosis or bulging.