Timely Reversal of Profound Acute Vision Loss in a Case of Dural Carotid-Cavernous Fistula

Dural carotid cavernous fistulae are abnormal connections between the carotid system and the cavernous sinus via small shunt vessels. Anterior drainage of blood shunted through the cavernous sinus into the orbital venous system accounts for the typical features of presentation. Vision loss has been reported by a variety of proposed mechanisms including elevated IOP, hypoxic venous stasis, retinal vessel occlusion, ischemic optic neuropathy, mechanical compression, and others. Many cases can be observed and spontaneous resolution is common, often preceded by partial thrombosis with transient worsening of symptoms. It is not clear whom it is safe to observe through this process. Treatment often restores vision unless the vision loss has occurred via glaucoma or an ischemic insult.