Protrusio Bulbi due to Dural Arterio-venous Fistula – An Attempt at Conservative Treatment

¹Press U. P., ¹Langefeld S., ²Moersdorf M.,
¹Augenklinik des Brüderkrankenhauses, Abteilung plastische rekonstruktive, Lid-, Orbita- und Tränenwegschirurgie, Orthoptik (Trier)
²Krankenhaus der Barmherzigen Brüder, Augenklinik (Trier)

Purpose: A case-report about conservative treatment in a woman with protrusio bulbi and conjunctival hyperaemia due to an arteriovenous dural fistula.
Patient: A 32 year old woman was sent to us with an unexplained protrusio bulbi and conjunctival hyperaemia. The protrusio and hyperaemia developed 3 months after an accident. The cerebral angiographie revealed a dural fistula in the sinus cavernous draining into the ophthalmic vein. We tried a conservative treatment by bulbar compression for embolization. Neurochirurgical interventions are very difficult due to the multiple very small feeding vessels.
Results: After two months of compression therapy a reduction of the protrusio and conjunctival hyperaemia was seen.
Conclusions: Posttraumatic arteriovenous dural fistula are very rare in contrast to posttraumatic carotidocavernous fistula. In our case the fistula probably developed after thrombosis of a vein or sinus. That would explain the appearance 3 months after the accident. An amelioration could be achieved by less dangerous conservative treatment. Perhaps we could then avoid neurochirurgical intervention through the fermoral artery or the ophthalmic vein.

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