Ophthalmic Artery Pseudoaneurysm: Causes, Symptoms, Diagnosis, and Treatment

What Is an Ophthalmic Artery Pseudoaneurysm?

Ophthalmic artery pseudoaneurysm is a rare medical condition characterized by abnormal dilation or bulging of the wall of the ophthalmic artery. The ophthalmic artery is a main blood vessel that supplies blood to the eye. Aneurysm causes bulging of all layers of the blood vessels, whereas pseudoaneurysm is said only if there is an injury or tear in the blood vessel wall. This injury or tear in the vessel wall will cause an accumulation of blood in the localized area outside the vessel wall. Ophthalmic artery pseudoaneurysm is caused by various reasons like trauma and infection that may cause severe symptoms that affect the vision of the eye.

What Are the Causes of Ophthalmic Artery Pseudoaneurysm?

Ophthalmic artery pseudoaneurysm is usually caused by traumatic injuries or due to any underlying medical conditions. Some of the common causes include

• Trauma: Direct trauma to the eye or neighboring facial structures due to any accident or fall may cause contusions and fractures. These contusions and fractures can cause damage to the delicate blood vessels, which results in the formation of pseudoaneurysms in the walls of the blood vessels of the ophthalmic artery.

• Surgical Trauma: Some orbital ocular or eye surgeries, especially those that involve manipulation of blood vessels and their adjacent structures, may have an increased risk of developing pseudoaneurysm in the wall of the ophthalmic artery, resulting in ophthalmic artery pseudoaneurysm.

• Vascular Conditions: Conditions of vascular structures like inflammation of arteries(arteritis) and other inflammatory conditions of the blood vessels and their adjacent structures cause an increased risk of developing pseudoaneurysm in the wall of the ophthalmic artery, which leads to ophthalmic artery pseudoaneurysm.

• Systemic Conditions: Certain systemic conditions like atherosclerosis and hypertension that affect the overall health of the blood vessels may indirectly cause pseudoaneurysm formation in the ophthalmic artery.

• Infection: In some cases, the weakening of the blood vessel wall of the eye due to infection in the blood vessel or its surrounding structures can potentially cause a pseudoaneurysm in the ophthalmic artery.

What Are the Symptoms of Ophthalmic Artery Pseudoaneurysm?

Symptoms of ophthalmic artery pseudoaneurysm can vary depending on the severity of the condition, which majorly depends on the location and size of the pseudoaneurysm. Some of the common symptoms include

• Sudden Vision Changes: Patients may experience sudden visual changes in blurriness or sometimes vision loss in response to compromised flow of blood to the eye.

• Eye Swelling: The affected eye may appear red or inflamed, and swelling may be present around the eye.

• Pain in the Eye: Pain may be present in and around the damaged eye. The pain may be due to pressure exerted by the pseudoaneurysm on adjacent structures.

• Pulsatile Exophthalmos: In certain cases, the patient may experience noticeable pulsation or bulging of the eye. This condition is said to be pulsatile exophthalmos. This pulsatile exophthalmos is caused by an abnormality in the blood flow in response to the pseudoaneurysm.

• Headache: Patients with ophthalmic artery pseudoaneurysm may have headaches. This headache may occur, especially if the blood flow to the brain is affected due to pseudoaneurysm.

How Is an Ophthalmic Artery Pseudoaneurysm Diagnosed?

The diagnosis of ophthalmic artery pseudoaneurysm is done by combining both clinical examination and imaging studies. Some of the diagnostic procedures include

Clinical Examination:

• Patients should reach an ophthalmologist or vascular specialist for a thorough examination that includes medical history which helps in identifying the risk factors that cause the development of pseudoaneurysm.

• An eye examination may be done to assess the visual acuity, movement of the eye, and eye appearance. During an eye examination, the physician may also look for signs like redness, swelling, and pulsatile exophthalmos.

Imaging Tests:

• Angiography - It is an essential diagnostic tool for diagnosing ophthalmic artery pseudoaneurysm. This imaging test is done by injecting a contrast dye into the vessel. This allows blood flow visualization to identify abnormalities like pseudoaneurysms.

• Ultrasound - Doppler ultrasound imaging is used to assess blood flow around and in the eye. Doppler ultrasound is used to identify the characteristics of pseudoaneurysms and their impact on blood circulation in blood vessels.

Additional Imaging Tests:

• Magnetic Resonance Imaging (MRI) Or Computed Tomography (CT) Scan - MRI and CT scans can be done to get detailed images of the eye and its adjacent structures. These tests help to confirm the presence of a pseudoaneurysm. It may also be used to evaluate the extent of pseudoaneurysm.

Collaboration With Other Specialists: Collaborating with other medical specialists in the case of ophthalmic artery pseudoaneurysm depends on the underlying cause or any associated conditions. For ophthalmic artery pseudoaneurysms, the eye specialist may collaborate with vascular surgeons or neurologists.

How Is Ophthalmic Artery Pseudoaneurysm Treated?

The treatment of ophthalmic artery pseudoaneurysm depends on various factors, including the size and location of the pseudoaneurysm, the underlying cause, and the severity of symptoms. Treatment options range from conservative measures to more invasive interventions. Here are common approaches:

• Conservative Management: For smaller pseudoaneurysms that are not causing significant symptoms or complications, a watchful waiting approach may be adopted. Regular monitoring and imaging studies can track the stability of the pseudoaneurysm over time.

• Endovascular Techniques:

  1. Coil Embolization: This minimally invasive procedure involves threading a catheter through blood vessels to the site of the pseudoaneurysm. Small metal coils are then deployed to block blood flow and isolate the pseudoaneurysm.

  2. Stent Placement: In some cases, a stent may be placed within the blood vessel to provide structural support and prevent further expansion of the pseudoaneurysm.

• Surgery: In more complex cases or when endovascular techniques are not feasible, surgical intervention may be considered. This could involve repairing or bypassing the damaged blood vessel to restore normal blood flow.

• Medication: Medications may be prescribed to manage associated symptoms or underlying conditions contributing to the development of the pseudoaneurysm, such as anti-inflammatory drugs or anticoagulants.

• Close Monitoring: Regardless of the chosen treatment approach, ongoing monitoring is crucial to assess the response to treatment, identify potential complications, and ensure the stability of the pseudoaneurysm.

Conclusion

Ophthalmic artery pseudoaneurysm is a rare vascular condition that requires careful diagnosis and appropriate management. Understanding the causes, symptoms, and available treatment options is crucial for healthcare professionals in providing timely and effective care for individuals affected by this condition. If a person suspects any symptoms related to ophthalmic artery pseudoaneurysm, it is essential to seek prompt medical attention for a comprehensive evaluation and appropriate intervention.