A varix is most often associated with a variable exophthalmos that changes with body position or with variations in intrathoracic pressure and has no audible bruit. This distinguishes a varix from a carotid-cavernous fistula. The problem most often manifests itself during the first or second year of life. The varix can be variably positioned deep within the orbit or in the subcutaneous tissues anterior to the orbital septum.
Occasionally acute and rapid increases in size (by thrombosis in or hemorrhage around the varix) mark the first presentation of the disorder. Despite this dramatic appearance, damage to vision by compression of the optic nerve is extremely uncommon.
The underlying genesis is thought to lie in a congenital venous malformation. A varix can be identified by using Valsalva maneuvers, ultrasonography, CT scanning, or MRI.
Usually no treatment is necessary. Only in cases of ocular or neural compression by acute hemorrhaging is it necessary to use surgical decompression. Identification and excision of the varix can be extremely difficult, and is not usually indicated.
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