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    In this retrospective analysis, the authors review the etiology and vision outcomes of patients with dilated superior ophthalmic vein (SOV).

    Study design

    The multicenter case series included 113 patients evaluated between 2001 and 2014. All records were reanalyzed by 3 masked neuroradiologists. A diagnosis of dilated SOV was made if the SOV measured greater than 3.0 mm in diameter on CT or MRI orbital imaging. Investigators excluded any patients with enlarged SOV that was found to be a normal variant without evidence of any disease.


    Of 113 patients, 75 were women and 38 were men.

    The most frequent etiology for dilated SOV was cerebral vascular malformation (n=92, 81%). Within the vascular malformation group, the most common diagnoses were dural-cavernous fistula (n=50) and carotid-cavernous fistula (21). Other non-fistula etiologies included superior ophthalmic vein thrombosis (6), idiopathic orbital inflammation (5), orbital lymphoma (1), thyroid eye disease (1) and orbital cellulitis (1).

    Visual impairment was observed in 26% at presentation and persisted in 22% at last follow-up.


    The study was limited by its retrospective nature and lack of standardization among imaging modalities and clinical exam findings. There is a potential referral bias as many cases were contributed by neurosurgeons or interventional neuroradiologists.

    Clinical significance

    This study represents the largest report of dilated SOVs to date. Given the aggressive nature of some vascular entities, quick clinical and radiographic recognition may be needed for prevention of potentially vision threatening complications. It is important to consider entities other than vascular fistulas should imaging and ophthalmic findings point in this direction.