Posttraumatic carotid-cavernous fistula is a very rare complication that can occur in patients with craniomaxillofacial trauma. Symptoms involve headache, diplopia, ptosis of the upper lid, conjunctival chemosis, pulsating exophthalmos, and ophthalmoplegia. Diagnosis can be challenging because various pathologic entities can present with similar symptoms such as superior orbital fissure syndrome, orbital apex syndrome, retrobulbar hematoma, and cavernous sinus syndrome. However, accurate and early diagnosis is of utmost importance because treatment delay may lead to blindness or permanent neurologic deficits. In this article, a case of posttraumatic carotid-cavernous fistula that was twice misdiagnosed is presented.
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