Purpose: This study investigated demographics, clinical profiles, imaging results, and treatment outcomes in patients with carotid cavernous fistula (CCF). Methods: This retrospective analysis examined medical records of the patients with CCF from January 2016 to January 2022. The study included 51 cases: 34 traumatic and 17 spontaneous CCFs. Results: A total of 51 patients with CCFs was analyzed. Traumatic CCF (34 patients, 66.7%) was more common than spontaneous CCF (17 patients, 33.3%). Traumatic CCF predominantly affected male patients, while spontaneous CCF was more frequent in female patients (p = 0.005). Clinical signs including proptosis and lagophthalmos were more common in traumatic CCF, with significant differences in eye movement restriction (p = 0.006) and bruit (p = 0.008). According to the Barrow classification, all spontaneous CCF cases were categorized as types B, C, or D, whereas traumatic CCF was predominantly classified as type A (p < 0.001). Endovascular treatment was more effective than conservative treatment in reducing clinical signs of traumatic CCF (p < 0.05), while no significant differences were observed in outcomes for spontaneous CCF between the two approaches. Conclusions: Spontaneous CCF is less common than traumatic CCF in this study cohort. Traumatic and spontaneous CCF may have different clinical characteristics. Eye movement restriction and bruit are more frequently observed in traumatic CCF. After treatment for traumatic CCF, the incidence of proptosis, conjunctival abnormalities, and bruit is significantly lower in patients who undergo endovascular treatment compared to those who receive conservative management. © 2025 The Korean Ophthalmological Society.