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

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.

Intermittent and Unilateral Chorioretinal Folds due to Combined Chiari 1 Malformation and Basilar Invagination

“…There was no evidence of allergy or infection as a cause of conjunctival edema. CSF was previously thought to only drain through the arachnoid villi and granulations, however, recent evidence suggests that CSF drains through other pathways [19]. Koh et al [20] in their review of the literature concluded that the majority of flow of CSF is along the cranial nerves and into extracranial lymphatics.…”