Pulsatile Exophthalmos: Effect of Orthostatic Pressure Difference

A 65-year-old man fell onto his face and had left-sided inferolateral dystopia, isocoric and reactive pupils, and binocular hematoma. Computed tomography scanning demonstrated a left-sided orbital roof fracture. On reevaluation at 24 hours, a pulsatile exophthalmos of his left eye was noted. This was only present when the patient was supine and disappeared when the patient sat up; it did not disturb the patient. At a checkup 7 days posttrauma, the dystopia and the pulsation were no longer present. The patient showed no radiological signs of an arteriovenous fistula, so we have to hypothesize that the slight elevation in intracerebral blood pressure when lying down was enough to cause the pulsation.