J Korean Ophthalmol Soc.  2013 Apr;54(4):662-666. 10.3341/jkos.2013.54.4.662.

A Case of Bilateral Septic Cavernous Sinus Thrombosis after Facial Trauma

• Youn SM
• Lee SG
• Yang JW

• KMID: 2216951
• DOI: http://doi.org/10.3341/jkos.2013.54.4.662

Abstract

PURPOSE
We report a case of a patient with ptosis, lid swelling, limitation of ocular movement, and visual disturbance after a trauma. The patient was diagnosed with unilateral orbital cellulitis, ophthalmic vein thrombosis and bilateral septic cavernous thrombosis and treated.
CASE SUMMARY
After head and facial area trauma that occurred 1 month earlier, a 56-year-old man suffered from ongoing visual loss, limitation of ocular movement in all directions, proptosis in the left eye and abduction limitation of the right eye. A week before admission, mild fever and chills were also present. At admission, visual acuity of the left eye was no light perception and pupil reflex was lost. Brain MRA and MRI indicated dilation and thrombosis of the left superior ophthalmic vein, left orbital cellulitis and inflammation in bilateral cavernous sinuses. The patient was immediately treated with systemic antibiotics and steroid injection. Coagulase negative staphylococci were detected in blood culture.
CONCLUSIONS
Infection caused by facial trauma spread through the facial area's venous plexus and caused orbital cellulitis. As a result, septic cavernous sinus thrombosis and ophthalmic vein thrombophlebitis occurred. Serious complications can occur after facial trauma, thus rapid differential diagnosis and appropriate treatment are important in determining prognosis.

Keyword

Cavernous sinus thrombosis; Facial trauma; Ophthalmic vein thrombophlebitis; Trauma

MeSH Terms

Anti-Bacterial Agents
Brain
Cavernous Sinus
Cavernous Sinus Thrombosis
Caves
Chills
Coagulase
Diagnosis, Differential
Exophthalmos
Eye
Fever
Head
Humans
Inflammation
Light
Orbital Cellulitis
Prognosis
Pupil
Reflex
Thrombophlebitis
Thrombosis
Veins
Visual Acuity
Anti-Bacterial Agents
Coagulase

Figure

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  Figure 1. Patient's photographs of initial presentation show (A) exophthalmos and (B) chemosis of the left eye. Orbit M RI before treatment shows (C) heterogeneous enhancement in both cavernous sinus which means inflammatory change (arrow) and (D, E) engorged left superior ophthalmic vein with contrast filling defect which means thrombophlebitis (arrow).

• 

  Figure 2. Patient had been treated with steroid and antibiotics for 5 days. Patient's photographs show that (A) exophthalmos and chemosis of the left eye improved, but, (B) ocular movement limitation remains in both eyes. At 2 weeks after treatment, orbit M RI shows improvement of (C) cavernous sinus thrombosis, (D) left superior ophthalmic vein thrombosis and (E) left orbital cellulitis (arrow).

Reference

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