Neuro-Ophthalmic Vascular Disease

This 27-year-old woman had no past ocular history and presented with 3 weeks of redness OS that has been treated by the referring doctor as allergic conjunctivitis. She was referred for evaluation when she developed binocular diplopia. Her past medical history included phlebitis and one miscarriage out of two pregnancies. When seen, she already felt that she might be improving. Her acuity, color plates, and fields were normal; remarkable features were 4 mm proptosis OS, exodeviation of 7 PD and a left hyperdeviation of 3 PD, full ocular rotations, mild chemosis, conjunctival congestion without arterialization OS, and some mild venous engorgement of the left fundus. The MRI shows partial flow, probably recanalizaton corresponding to her clinical improvement, in the enlarged left superior ophthalmic vein. Her serologic workup, including antiphospholipid antibodies, was normal despite her history, and she has resolved. Pair with Images 95_45 and 95_46.