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Orbital varices and orbital wall defects
  1. N Islam,
  2. K Mireskandari,
  3. G E Rose
  1. Moorfields Eye Hospital, London EC1V 2PD, UK
  1. Correspondence to: Mr G E Rose Orbital Service, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK;

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Orbital varices are a vascular hamartoma typified by a plexus of low pressure, low flow, thin walled and distensible vessels that intermingle with the normal orbital vessels.1–4 If freely communicating with the orbital circulation, engorgement of varices can occur by increasing venous pressure through the Valsalva manoeuvre,5 bending posture,6 coughing or straining and these, in turn, lead to the clinical characteristics of variable proptosis, intermittent pain, and orbital haemorrhage.7,8

Observation is usually warranted for small lesions, but surgical intervention may be necessary in advanced cases: indications for surgical intervention include non-resolving episodes of thrombosis, severe disfiguring proptosis or displacement of the globe, and optic nerve compression.1–3 Surgery can be extremely difficult, as varices are very friable and intimately intermixed with normal orbital structures; there is also a significant risk of visual loss as a result of haemorrhage or optic nerve damage, …

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