Abnormal ophthalmic veins: differential diagnosis and management using color Doppler imaging

Abstract

Objective: To evaluate the role of color Doppler imaging (CDI) in the diagnosis and management of patients with abnormal ophthalmic veins. Design: Records from patients with suspected abnormalities of ophthalmic veins who had been studied with color Doppler imaging were reviewed. Patients and methods: Twenty-three patients had abnormalities of their superior ophthalmic vein (SOV) due to anomalous SOV enlargement, carotid cavernous fistula (CCF), dural shunt, tumor, or Graves’ disease. Color Doppler imaging of the orbits was obtained initially and as needed during the course of each case. Abnormalities of superior ophthalmic vein included velocity greater than 8.26 cm/sec, anteriorly directed blood flow, and/or pulsatile waveform. Results: Incidental enlargement of SOV was associated with normal waveform velocity on CDI. Of three patients with CCF, two showed high velocity in one or both SOVs which resolved after embolization. One patient with a dural shunt had high SOV velocity. Four patients with clinical and CDI findings typical of dural shunt improved spontaneously and did not need angiography. Two patients with orbital tumors and one with intracranial tumor had evidence of increased venous outflow through the SOV. Two patients with Graves’ disease showed mild to moderate increase in SOV velocities. Conclusions: CDI is especially helpful in the diagnosis of incidental SOV enlargement and in management of low flow dural shunts.