Management of acute orbital hemorrhage with obstruction of the ophthalmic artery during attempted coil embolization of a dural arteriovenous fistula of the cavernous sinus.

Because of inability to access a cavernous-carotid fistula through conventional means, a superior ophthalmic vein approach was used to allow access for embolization. Although there was initially robust flow through both the fistula and the ophthalmic artery on angiography, the flow stopped during the procedure, and the patient was found to have an orbital hemorrhage. Immediately on emergent canthotomy and evacuation of the hemorrhage, angiographic evidence of restoration of flow was noted. This finding suggests that vision loss in orbital compartment syndrome may be due to arterial occlusion in some cases, and may be reversible if prompt action is taken.