Chemosis and proptosis of the right eye after direct trauma

A 24-year-old man presents with chemosis and proptosis of the right eye after direct trauma. MRI imaging reveals an abnormality. What would be the most unlikely clinical finding?

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  1. Elevated intraocular pressure
  2. Engorged conjunctival vessels
  3. Conjunctival laceration
  4. Abducens palsy

View Explanation

The MRI image reveals an enlarged right superior ophthalmic vein, a typical finding in a carotid-cavernous fistula. The fistula directs arterialized carotid blood into the superior ophthalmic vein causing reversal of flow. Other common findings include raised intraocular pressure secondary to increased episcleral pressure, bright red arterialized conjunctival vessels, and an audible orbital bruit. Multiple cranial palsies (related to cavernous sinus pathology) may also be present but a sixth nerve palsy is most common. A conjunctival laceration may be present but is not typically seen with this disorder.