Color Doppler imaging (CDI) has been used in ophthalmology to study vascular disorders including various orbital diseases. We report our experience with CDI in orbital diseases and review the literature. Patients and Methods: CDI was performed in selected patients with orbital diseases such as carotid cavernous fistula, Graves' ophthalmopathy, ocular melanoma, and orbital tumors. Results: Twenty-five patients underwent CDI. Seven had carotid cavernous fistula, four had choroidal melanoma, eight

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... had Graves' ophthalmopathy, and six had orbital tumors. In patients with carotid cavernous fistula, CDI revealed a prominent dilated superior ophthalmic vein and spectral wave-form analysis showed high-velocity arterialized blood flow in all cases. Patients with choroidal melanoma had an arterial signal with flow. In patients with Graves' ophthalmopathy, flow velocities in the ophthalmic and central retinal arteries were not significantly different from those in normal subjects. No blood flow signal was noted in patients with cavernous hemangioma, lymphoid hyperplasia, or meningioma, while one patient with hemangiopericytoma had multiple blood flow signals. Conclusion: CDI offers several advantages over computed tomography and magnetic resonance imaging in the evaluation of different orbital diseases. Safe, dynamic, and cost-effective, CDI provides a convenient way to not only diagnose and differentiate orbital tumors, but to monitor treatment efficacy as well. (J Med Ultrasound 2004;12:43-8) KEY WORDS: • color Doppler imaging • carotid cavernous fistula • choroidal melanoma • Graves' ophthalmopathy