The Hidden Berry, a Vascular Mystery: Unveiling a Comparison Between Two Cases of Orbital Cavernous Venous Malformation (OCVM)

Orbital cavernous venous malformations (OCVMs) are rare, benign vascular lesions found within the orbit, characterized by a cluster of dilated venous spaces surrounded by a fibrous capsule. These malformations can pose significant challenges in diagnosis and management due to their varied clinical presentations, ranging from subtle proptosis and visual disturbances to more severe complications such as orbital hemorrhage and nerve compression. The etiology of OCVMs remains largely unknown, though they are believed to be congenital in nature. Case 1 was a 31-year-old male patient who had experienced painless swelling and blurred vision in his left eye for 11 years, which gradually worsened after a stone struck his left eye. He presented with a painful, red left eye for five days. On presentation, there was a significant left eye exophthalmos with lagophthalmos. He was also treated for exogenous endophthalmitis due to a corneal ulcer. Computed tomography (CT) demonstrated a large multilobulated intraorbital soft tissue mass. Tumor debulking via a transconjunctival approach was done. Histopathology confirmed orbital cavernous venous malformation. His left eye vision remained poor due to the past infection and optic nerve compression. One month post operation, it was noted that his left eye had developed recurrent ocular cavernous venous malformation. Case 2 was a 42-year-old female patient who presented with painless swelling for three months, with insidious onset and double vision. There were no thyroid or constitutional symptoms. She had diplopia on left lateral gaze, levoelevation, and levoversion, with restriction of the extraocular muscles in the superotemporal, superonasal, and nasal directions. On examination, axial proptosis was noted, but there was no lagophthalmos. Anterior and posterior chamber findings were unremarkable. CT showed a well-defined extraconal soft tissue lesion at the medial aspect measuring 2.1cm x 1.4cm x 1.6cm. The patient underwent excisional biopsy via anterior orbitotomy through vertical lid split. Histopathology reported as orbital cavernous venous malformation. The patient is recovering well. The vital and functional prognosis with complete excision of OCVMs is generally excellent, but the complications from untreated proptosis can be devastating.