# Indirect Carotid Cavernous Fistula with Ocular Manifestations: A Case Report

## TL;DR

A 65-year-old woman with an indirect carotid-cavernous fistula showed eye symptoms that improved with manual carotid compression, highlighting a rare but treatable condition.

## Contribution

This case report highlights the spontaneous resolution of an indirect carotid-cavernous fistula in an elderly female using conservative management.

## Key findings

- Indirect carotid-cavernous fistulas can present with redness, proptosis, chemosis, headache, and ophthalmoplegia.
- External manual carotid compression can lead to significant symptom improvement in such cases.
- Elderly females are particularly susceptible to this condition, which can be sight-threatening.

## Abstract

Carotid-cavernous fistulas are rare entity with incidence of less than 1%, refers to abnormal connections between the carotid artery and cavernous sinus. Indirect types usually occur in elderly female patients and can resolve spontaneously with conservative management like external manual compression of the carotid artery. We report a case of 65-year-old female who presented with complaints of redness, proptosis, chemosis, headache and ophthalmoplegia in her right eye. Digital subtraction angiography revealed Barrow type B indirect carotid-cavernous fistulas. External manual carotid compression was done after which her symptoms improved significantly. Thus, indirect type carotid-cavernous fistulas can occur spontaneously and could be a sight threatening condition especially in elderly females but can resolve with conservative management.