Ciliary Body/Iris Appositioning Producing Mechanical Pupillary Defects in Carotid-Cavernous Sinus Fistula: An Overlooked Pathophysiologic Mechanism

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Title Ciliary Body/Iris Appositioning Producing Mechanical Pupillary Defects in Carotid-Cavernous Sinus Fistula: An Overlooked Pathophysiologic Mechanism
Creator Margarita G. Todorova; Cameron F. Parsa
Affiliation Department of Ophthalmology (MGT), University of Basel, Basel, Switzerland; and Quinze-Vingts National Ophthalmology Hospital (CFP), UPMC-Sorbonne Universities, Paris, France
Abstract Background: Variable pupillary responses have been described with carotid-cavernous sinus fistulas. These often are associated with a decrease in visual acuity and attributed to retinal ischemia. We propose a novel pathophysiologic mechanism for changes in pupillary reactivity involving anatomic changes secondary to choroidal effusion. Methods: To demonstrate proof-of-concept, we investigated 2 consecutive patients with carotid-cavernous sinus fistulas and pupillary disturbances using repeated refractions and anterior segment ultrasound biomicroscopy. Results: Ultrasound biomicroscopy demonstrated choroidal thickening and ciliary body effusion with forward rotation of the lens-iris diaphragm altering refraction and mechanically limiting iris movements. Conclusions: Where there are acute elevations in orbital venous pressure causing ciliary body effusion, changes in visual acuity and pupillary abnormalities can be produced by mechanical effects.
Subject Carotid-Cavernous Sinus Fistula; Choroid Diseases; Ciliary Body; Humans; Iris; Male; Microscopy, Acoustic; Middle Older people; Pupil; Retinal Diseases; Visual Acuity
OCR Text Show
Date 2017-03
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6kh4t7j
Setname ehsl_novel_jno
ID 1353374
Reference URL https://collections.lib.utah.edu/ark:/87278/s6kh4t7j
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