Increased Ocular Pulse Amplitude Associated with Unilateral Dysgenesis of the Orbital Roof

INTRODUCTION: Two patients (one with neurofibromatosis type 1) presented with unilateral ocular pulsation. METHODS: A CT scan of the orbits revealed extensive dysgenesis of the orbital roof with herniation of the frontal lobe into the orbit in both cases. PASCAL dynamic contour tonometry was performed. RESULTS: The ipsilateral ocular pulse amplitude (OPA) was greater than the contralateral side, and the ocular pulse waveform morphology more closely approximated the known intracranial waveform in these patients. CONCLUSIONS: We hypothesize that the greater OPA was due to stronger transmission of the intracranial pressure waveform amplitude and morphology in the absence of the orbital roof.