Chemosis, pulsatile proptosis, and an ocular bruit describe a classic triad for which condition?

• A. Tolosa-Hunt syndrome
• B. Orbital cellulitis
• C. Retinal detachment
• D. Carotid-Cavernous Fistula

Answer: (D)

This triad is a classic presentation of a carotid-cavernous fistula. When arterial blood shunts into the cavernous sinus, the orbit becomes venously congested. That elevated venous pressure causes the eye to protrude (proptosis) and the conjunctiva to swell (chemosis). The flow through the fistula is turbulent, producing an audible bruit over the eye. These signs together are highly characteristic of a carotid-cavernous fistula.

Other conditions can cause one or two of these features but not the full combination. Tolosa-Hunt syndrome typically presents with painful ophthalmoplegia from inflammation in the cavernous sinus rather than a pulsatile proptosis with a bruit. Orbital cellulitis often has fever and infectious signs with proptosis but not usually a vascular bruit. Retinal detachment affects vision with floaters or a curtain and does not cause chemosis, pulsatile proptosis, or an orbital bruit.