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Aneurysms or malformations of the intraorbital vessels are lesions which in spite of the large number of cases cited in the medical literature have rarely been verified, the larger part being merely clinical descriptions.In 1823, Guthrie described the first case of intraorbital aneurysm proved by post-mortem examination. Pulsating exophthalmos was the most striking feature of this case, and for many years after this description pulsating exophthalmos was thought to be pathognomonic of intraorbital aneurysm (Dempsey, 1886; Nunneley, 1859). In 1865 Nunneley extended the pathological possibilities by describing two cases of pulsating exophthalmos due to an aneurysm of the internal carotid in one case and to an intracranial extension of a thyroid carcinoma in the other.In 1870, Delens reviewed the whole problem of pulsating exophthalmos and identified a carotid cavernous fistula as the most common cause, and from that time intraorbital aneurysms seem to have been almost forgotten. This can be seen in the publications of Locke (1924) and Martin and Mabon (1943) Examination showed a normal young woman, bright and alert. The superficial venous network of the eyelids was perhaps more obvious than usual, especially on the left side. A mild exophthalmos was present on the same side, the protrusion being 6 mm. more than on the right side. With the head erect, the left palpebral fissure was slightly narrower than the right (Fig. 1A), and there was also mild conjunctival congestion. The pupils were equal and reacted normally. Pressure on the left jugular vein, or bending of the head, produced palpebral swelling and a slight increase of the left exophthalmos (Fig. IB).The visual acuity was 90/100 in the right eye, and 50/100 in the left eye. With proper correction for its myopic astigmatism, the visual acuity in both eyes rose to 100/100. Ocular motility was normal, but there was a mild intermittent imbalance of the muscular equilibrium, due to deviation of the left eye. The visual fields showed in the right eye a mild upper temporal depression. In the left eye there was a concentric reduction for white and colours and a depression in the upper nasal quadrant.The fundi were normal except for a mild venous congestion on the left. Otherwise, the neurological and systemic examinations were normal. The

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