Assigned status Up to Date by Richard Scawn, MD, FRCOphth on June 29, 2016.
Orbital varices are venous malformations of the orbit, vascular hamartomas.  They consist of a plexus of thin-walled distensible low flow vein-like vessels that are commonly intrinsic to the normal circulation.
Orbital varices commonly present from early childhood to late middle age. Most varices are unilateral and located superonasally.
Physical examination, Signs/Symptoms
Proptosis is a common presenting sign. Proptosis is the result of engorgement of varices and is typically intermittent and slowly progressive. This clinical sign is elicited by increasing the orbital venous pressure through coughing, straining, Valsalva maneuver, bending of the head down.  Complications associated with varices include acute orbital hemorrhage, thrombosis (often with sudden pain, proptosis, decreased vision) and optic nerve compression. Patients with long-standing lesions may develop enophthalmos from atrophy of surrounding fat, although correction of exophthalmos is expected with valsalva manoeuvres to reduce venous return.
Treatment is usually conservative. Incisional biopsy should be avoided because of the risk of hemorrhage. Surgery is reserved for relief of significant pain or in cases of vision threatening compressive optic neuropathy. Indications for surgical intervention include: nonresolving episodes of thrombosis, severe disfiguring proptosis or displacement of the globe and optic nerve compression. Specialized techniques such as coil embolization and carbon dioxide laser surgery have also been reported to reduce symptoms. 
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