Contents
Vascular hamartoma typified by a plexus of low pressure, low flow, thin walled and distensible vessels that intermingle with the normal orbital vessels.
- Orbital venous varices are the M/C cause of spontaneous intraorbital hemorrhage
- M/C cause of reducible & intermittent proptosis
Aetiology
Primary orbital varices:
Idiopathic and confined to the orbit
Secondary orbital varices:
Acquired causes
- Carotid-cavernous fistula
- Dural arteriovenous fistulas
- Intracranial arteriovenous malformations
Pathophysiology
Orbital varices typically result from a congenital weakness in the postcapillary venous wall. This can lead to the proliferation and dramatic dilation of the valveless orbital veins. These varices distend during maneuvers that increase venous pressure depending on the extent of communication with the venous system.
Clinical features
- Unilateral stress proptosis (non-pulsatile, intermittent and reducible):
- Manifests with activities that increase venous pressure (coughing, crying, bending, straining, breath holding, or Valsalva maneuver)
- Intermittent diplopia
- Intermittent periorbital pain

Complications
Can lead to visual loss
- Spontaneous intraorbital hemorrhage
- Acute thrombosis (acute onset of retro-orbital pain, proptosis, and decreased visual acuity)
- Lacrimal mass (larger lesions involving the superior ophthalmic vein)
Diagnosis
Imaging:
During imaging, dynamic maneuvers such as Valsalva, in conjunction with specific positioning, can aid in the visualization of varix
- Ultrasound (USG)
- Colour Doppler imaging
- Computerized tomography (CT)
- MRI
- Magnetic resonance venography (MRV)

Differential diagnosis:
Other orbital venous malformations
- Varicocele
- Venous angioma
- Lymphangioma
Management
Most orbital varices may be managed conservatively and only warrant surgery in the presence of recurrent thrombosis, disfiguring proptosis or acute visual loss.