A case of tricuspid regurgitation and congestive cardiac failure presenting with orbital pulsation

Tricuspid regurgitation is a common abnormality, which is often only diagnosed on echocardiography, and not on clinical examination. This case report describes the rare presentation of eyeball pulsation seen in a patient with tricuspid regurgitation, presenting with severe congestive cardiac failure. The eyeball pulsation diminished after treatment with diuretics, synchronously with a lowered jugular venous pressure. Given the proposed mechanism behind eyeball pulsation, this sign is likely to have high specificity for tricuspid regurgitation and clinical progression in fluid overload. We propose that clinicians should routinely or at least be alert to looking for eyeball pulsation in the clinical examination.