In the absence of a history of trauma, patients usually present because they have orbital complaints related to increased venous pressure. The lack of dilation of the superior ophthalmic vein or other imaging features does not exclude the diagnosis and should not preclude angiography. The diagnosis is confirmed by angiography, which should be performed with consideration of the options for the ultimate treatment of the disease. Diagnostic arteriography is best performed by those who are charged with the ultimate treatment of the disease. Indications Patients with CCF present with a combination symptoms and signs of venous hypertension and congestion, including proptosis , extraocular muscle enlargement and edema in the orbital fat, chemosis, scleral injection , and conjunctival hemorrhages .
Visual decline can be fulminate and necessitate emergent therapy.
Thus, close ophthalmologic monitoring is an important component in management. Pharmacologic management of glaucoma requires close monitoring of intraocular pressure by the ophthalmologic team members. The bruit can often be heard on examination with a stethoscope, either over the involved eye or elsewhere over the cranium. Observation of a bruit is an important component in management, because such surveillance represents a noninvasive means for repeated assessment of closure or recurrence of a fistula during treatment. Its presence or absence should be recorded at the time of the initial examination.