Pulsating exophthalmos, bruit, and conjunctival chemosis have long been regarded as the three classical symptoms of carotid cavernous fistula. If the main venous drainage is via the superior ophthalmic vein, this triad will probably be present; if not, the triad is likely to be absent or incomplete.

The symptoms of patients with spontaneous CCF are commonly milder than those in traumatic CCF cases. This difference is attributable to the difference in the volume of blood flow into the cavernous sinus. In addition, the specific venous drainage from the cavernous sinus is important.