Orbital varices: a new technique for noninvasive diagnosis.

Orbital venous varices can be a perplexing imaging problem, as they typically are expanded only during periods of venous hypertension, which is transmitted cephalad owing to the lack of valves in the internal jugular veins [1]. When venous pressure is not elevated , orbital varices may collapse and be undetectable on routine imaging studies, such as axial CT scans of the orbit. A provocative test frequently is necessary to demonstrate these lesions, and should be performed in patients with intermittent proptosis and diplopia, such as when coughing, straining , or leaning forward . Improved visualization of orbital varices on CT scans obtained during the Valsalva maneuver and in coronal (as compared with axial) scans has been described [1 , 2] , and methods of diagnosis that make use of manual compression of the neck have been described in the Chinese literature [3]. We describe a new technique for evaluating patients with symptoms suggestive of orbital varices that is noninvasive and does not require IV contrast administration. We believe this technique will produce more reliable and consistent results than studies that use the Valsalva maneuver and manual neck compression. Our technique is also useful for patients who are unable to assume the position for direct coronal CT scanning .