Sight-threatening intraocular pressure due to an upper arm dialysis fistula

Arterialised blood flow within the cavernous sinus causes an ocular bruit, pulsating exophthalmos, diplopia, conjunctival chemosis, orbital pain, dilated and arterialised conjunctival vessels, raised intraocular pressure, and proptosis. Recanalisation of the occluded brachiocephalic vein was an alternative therapeutic option but we chose not to do this because of the long-standing nature of the occlusion, and intimal hyperplasia caused by the shunt that would have increased the likelihood of stent occlusion.