Dilated superior ophthalmic vein: systemic associations

Abstract

Purpose: To review systemic associations of patients with dilated superior ophthalmic veins (SOV) in the absence of orbital, cavernous sinus, or neurological disease.

Methods: Retrospective review of patients who had dilated SOVs with a diameter of ≥ 5.0 mm. Patients with a dilated SOV secondary to orbital, cavernous sinus or neurological disease were excluded. Patient demographics, past medical history, and SOV diameters on initial and follow up scans were collected. The maximum diameter of the SOV was taken perpendicular to the long axis of the SOV.

Results: Nine cases were identified. Patients ranged in age from 58 to 89 years and six out of nine were female. The dilated SOV involved both eyes in two cases, left eye in five cases and right eye in two cases. Three patients had dilated SOV likely secondary to raised venous pressures from decompensated right heart failure (n = 1), pericardial effusion (n = 1) and left ventricle dysfunction secondary to a myocardial infarction (n = 1). Five patients had a significant history of previous ischaemic heart or peripheral vascular disease. Two patients had risk factors for venous clotting disease whilst one patient had a history of giant cell arteritis and vertebral artery dissection.

Conclusion: A dilated SOV may raise concern for life threatening conditions such as a carotid cavernous fistula and may prompt additional investigations. A dilated SOV may be reversible and secondary to raised venous pressures due to cardiac failure. Other cases may be seen in patients with significant cardiovascular risk factors, possibly due to changes in vasculature.

Keywords: Computed tomography; Dilated Superior ophthalmic vein; Magnetic resonance imaging; Orbit.

Fig. 1

The Superior ophthalmic vein measurement was taken perpendicular to the long axis of the SOV on T2-fat suppressed coronal sequences

Fig. 2

Initial T1-Weighted coronal MRI (A) from Case 1 showing bilateral SOV dilatation. This patient presented with decompensated right heart failure. A follow up scan (B) two years later revealed normal SOVs. Initial coronal CT scan (C) showing bilateral SOV dilatation in Case 7. This patient had a pericardial effusion secondary to breast cancer. A follow up CT scan (D) showed normal SOVs

Fig. 3

Initial (A) and follow up (B) coronal T2 fat suppressed scans in case 2 showing a left dilated SOV. Initial CT (C) and follow up coronal MRI (D) showing a left dilated SOV in case 3. Case 4 shows a right dilated SOV on initial (E) and follow up (F) scans