Sabihud Din Ahmad, Abdul Rafe, Atif Shiraz, Imran Ahmed.
Indirect cartotid cavernous fistula.
Pak Armed Forces Med J Jan ;61(2):311-3.

Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The indirect fistula develops because of a leak from the weakened artery due to some pre existing pathology. The ­onset is gradual with mild symptoms, hence a high level of suspicion is needed for their diagnosis which is facilitated by various imaging techniques like CT scan, MRI, Doppler, ultrasonographv, MRA, and angiography1. Spontaneous resolution of these fistulas have been reported2 hence they are managed conservatively. Weighing the risks, angiography is performed only when active intervention is planned. Ophthalmologist may be the first physician to encounter a patient with clinical manifestations of CCF and this article stresses the need to keep this differential diagnosis in mind to minimise mortality and morbidity.

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