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Conjunctival oedema as a potential objective sign of intracranial hypertension: a short illustrated review and three case reports

  • Case Report - Brain Injury
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Abstract

Periorbital and conjunctival oedema has been reported anecdotally by patients with raised intracranial pressure states. We present three clinical cases of this phenomenon and discuss the current evidence for pathways by which cerebrospinal fluid (CSF) drains in relation to conjunctival oedema. We reviewed the available literature using PubMed, in regards to conjunctival oedema as it relates to intracranial hypertension, and present the clinical history, radiology and orbital photographs of three cases we have observed. Only one previous publication has linked raised intracranial pressure (ICP) to conjuctival oedema. The weight of evidence supports the observation that the majority of CSF drains along the cranial nerves as opposed to via the arachnoid projections. Conjunctival oedema may be a clinical manifestation of CSF draining via the optic nerve in elevated ICP states.

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Authors and Affiliations

  1. Kenneth G. Jamieson Department of Neurosurgery, Royal Brisbane and Womens Hospital, Butterfield St, Herston, 4029, Brisbane, Australia

    Nicholas Toalster & Rosalind L. Jeffree

Authors
  1. Nicholas Toalster
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  2. Rosalind L. Jeffree
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Correspondence to Rosalind L. Jeffree.

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Comment

The authors have provided a series of three rare cases regarding conjunctival oedema associated with raised intracranial pressure. To date, only one further publication has linked intracranial hypertension to oedema of the conjunctivae (Hay [6]), although the phenomenon probably occurs not so infrequently, despite not previously being more often described. This is a report calling our attention to a sign, which might be an additional clinical indicator of increased intracranial pressure. As conjunctival oedema could be caused by a multitude of ocular and non-ocular aetiologies, the coincidence of different causes and the concomitance of one or more of these aetiologies with intracranial hypertension should be considered for differential diagnostic considerations and adequate patient management.

Markus F. Oertel

Bern, Switzerland

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Toalster, N., Jeffree, R.L. Conjunctival oedema as a potential objective sign of intracranial hypertension: a short illustrated review and three case reports. Acta Neurochir 155, 2159–2163 (2013). https://doi.org/10.1007/s00701-013-1797-7

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  • DOI: https://doi.org/10.1007/s00701-013-1797-7

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