Phlebography of the orbital venous system and the cavernous sinus

Thirty-four patients with unilateral exophthalmos and two patients with suspected lesions involving the cavernous sinus were investigated by angular vein or frontal vein phlebography. The techniques used and the findings are described. Phlebography of the orbit by percutaneous angular or frontal vein injection is shown to be a valuable diagnostic aid in the study of diseases of the orbit. The technique is complementary to arteriography which is the procedure of choice for orbital arterial malformations and aneurysms. Phlebography is the procedure of choice in venous diseases (varices and venous angiomas). It is a useful substitute when other investigations are unsuccessful or give inconclusive results. The risk rate is low but there is a small risk which can be minimised by careful aseptic technique. The apparent universal reluctance to use the technique is not justified on theoretical or practical grounds. The use of both angular vein and frontal vein injection assures almost universal success, in demonstration of the orbital venous system and the cavernous sinus.