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Presenting Characteristics for Symptomatic, as Compared to Asymptomatic (assumed), Orbital Cavernous Venous Malformations

Aims: To compare the characteristics for symptomatic and asymptomatic orbital cavernous venous malformations (OCVMs). Methods: A retrospective case-note review for patients with OCVMs was performed for demographics and presenting features. Results: Four hundred and fourteen patients (258 female; 62%) presented at a mean age of 49.4 years and all were unilateral. Ninety-two (22%) asymptomatic OCVMs were found a decade later than 322 symptomatic patients (57.8 vs. 47.0 years; p < 0.001). Patients with symptomatic OCVMs had an average symptom duration of 3.3 years with the commonest being altered vision (57%), proptosis (55%), orbital ache (21%), and diplopia (13%). Visual obscurations were reported by 11% of symptomatic patients, whereas 30% had a hyperopic shift. Mean LogMAR was 0.39 for symptomatic OCVMs and 0.1 for asymptomatic (p < 0.001), and a relative afferent pupillary defect was detected in 38% symptomatic and 7% asymptomatic patients (p < 0.001). Mean relative exophthalmos was 3.9 mm in symptomatic patients and 1.5 mm in asymptomatic (p < 0.001), but there was no correlation between age and exophthalmos. Symptomatic lesions had higher rates of nonaxial displacement (30% vs. 7%; p < 0.00001), more palpable masses (17% vs. 2%; p = 0.0001), and more impairment of motility (29% vs. 10%; p = 0.0024). Fundal abnormalities were noted in 63% of patients with symptomatic OCVMs, as compared to 26% of asymptomatic (p < 0.0001). Conclusion: Symptomatic OCVMs may present with reduced visual function, either due to the globe or optic nerve compression, or proptosis. Asymptomatic (presumed) OCVMs— representing 22% of all OCVMs—are usually found a decade later than symptomatic lesions, and a few may have only mild functional impairment. Symptomatic orbital cavernous venous malformations typically present with proptosis or reduced vision. Asymptomatic (presumed) orbital cavernous venous malformations account for 22% of patients, are detected a decade later, and most have only mild, if any, visual impairment.