A shotgun wedding

•Trauma from gun kickback may cause a CCF•Proptosis, chemosis, and injection are common symptoms resulting from a CCF, but may be inconspicuous early in the disease process•Prompt embolization of a CCF may preserve vision A 69-year-old woman developed a carotid-cavernous fistula (CCF) after firing a shotgun. Initially, the patient had mild visual symptoms, but later on developed prominent features of CCF including chemosis, proptosis, ophthalmoparesis and conjunctival injection . The fistula was embolized via an intravascular coiling procedure. We are unaware of another patient who developed a CCF due to blunt force from shotgun use.