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Carotid-cavernous fistula is a well-recognized complication of blunt orbital or head trauma and typically presents within days with painful proptosis, ocular bruit/bruise, and conjunctival or periorbital congestion. Post-traumatic cavernous sinus thrombosis is rare, whereas sphenoid fracture or carotid aneurysm alone do not usually cause acute proptosis. Hence the most likely diagnosis here is a traumatic carotico-cavernous fistula [Kasturi, 2019, PMID 30936337; Bertolini, 2024, PMID 37996776].