• Pooja Shrestha, Angira Shrestha, Tina Khoju, Richa Makaju, Rajani Keshari, Rahul Gupta, and Nigi Shrestha.
• Department of Ophthalmology, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal.
• JNMA J Nepal Med Assoc. 2024 May 31; 62 (274): 407410407-410.

AbstractCarotid-cavernous fistulas are rare entity with incidence of less than 1%, refers to abnormal connections between the carotid artery and cavernous sinus. Indirect types usually occur in elderly female patients and can resolve spontaneously with conservative management like external manual compression of the carotid artery. We report a case of 65-year-old female who presented with complaints of redness, proptosis, chemosis, headache and ophthalmoplegia in her right eye. Digital subtraction angiography revealed Barrow type B indirect carotid-cavernous fistulas. External manual carotid compression was done after which her symptoms improved significantly. Thus, indirect type carotid-cavernous fistulas can occur spontaneously and could be a sight threatening condition especially in elderly females but can resolve with conservative management.

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