Walsh & Hoyt: Diagnosis

The diagnosis of a dural CCF should be considered in any patient who spontaneously develops a red eye, chemosis of the conjunctiva, abducens nerve paresis, or mild orbital congestion with proptosis. Auscultation of the orbit may disclose a bruit, but this is relatively uncommon. Tonometry, however, usually shows asymmetry of the ocular pulse with a greater pulse amplitude on the side of the lesion. The asymmetry in the amplitude of the ocular pulse can be appreciated using any tonometer, although we prefer to use a pneumotonometer which provides a direct measurement and an objective record of the pulse.