Acute Compressive Optic Neuropathy Due To Spontaneous Orbital Varix Thrombosis

A 76 year old woman with a prior history of right abducens palsy and Horner syndrome related to multiple sclerosis presented with acute left-sided proptosis and ptosis associated with mild pain, nausea and one episode of vomiting. She denied any recent trauma, headache or foreign body sensation. She was unaware of any change in vision at that time. An initial evaluation within hours of her presentation revealed hand motion vision and a relative afferent pupillary defect in her left eye. Acuity OS was 20/30 six months prior. There was marked ophthalmoplegia in all planes and slightly elevated intraocular pressure OS at 24 mm Hg.