Presentation
The patient presented with a repeat syncopal episode and a fall for investigation. History of chronic hypertension, previous craniofacial trauma, and glaucoma with ophthalmological surgical intervention.
Patient Data
In view of past and recent recurrent trauma (syncope and fall) the following findings were found:
There is focal right prefrontal extracranial soft tissue swelling and acute subgaleal hematoma corresponding to site impact and fall during the current syncopal episode. The cranium is intact throughout.
Chronic non-united right posterior maxillary antral wall fracture and right inferior orbital blowout fracture. There is also a chronic left medial orbital blowout fracture with herniated orbital fat and no evidence of muscle or optic nerve entrapment.
There is a previous right zygomatic bone fracture and surgical repair thereof with the regional metallic artifact.
There is a previous left retrolental artificial lens implantation (cataract surgery).
There are bilateral glaucoma drainage devices in situ with calcification of the left-sided device.
The devices are within the left superonasal orbital quadrant and right superotemporal orbital quadrant.
There is incidental extensive extracranial vascular calcified atherosclerotic plaque.
There is a metallic artifact relating to the previous surgical repair of the right zygomatic bone.
There is right prefrontal soft tissue swelling and focal hematoma relating to the syncopal fall and blunt impact.
There is mild nonspecific microvascular ischemic change.
There are bilateral mastoid effusions.
Diffusion imaging was negative given the recent syncopal episode with a normal MRA.
There are bilateral glaucoma drainage devices in situ, specifically the left superonasal orbital quadrant and right superotemporal orbital quadrant.
The drainage devices are best identified on sagittal and coronal sequences.
There is an incidental empty sellar.
Left and right glaucoma drainage reservoir.
Demonstrated as a curvilinear fluid signal intensity device overlying the superior globe on sagittal imaging.
Case Discussion
The patient has confirmed glaucoma and bilateral Ahmed drainage valves in situ.
Glaucoma drainage devices divert aqueous humor from the anterior chamber to a regional external reservoir and thereby control intraocular pressure.
There are two types of devices depending if the device has an intraocular pressure regulating valve or not.
Nonvalved devices include the Molteno, Baerveldt, Shocket, and the Eagle vision implant.
The most commonly used valved implant is the Ahmed glaucoma valve (AGV).
The devices are usually placed in the superotemporal quadrant due to ease of surgical access and to reduce the risk of motility disturbances.
The devices are placed in the inferior quadrants only if there is silicone oil in the globes.
Disclosure: I, Ashesh Ishwarlal Ranchod, have no actual or potential ethical or financial conflict of interest in relation to the devices. This case is not intended to be a personal endorsement or recommendation of this product.
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