A Case of Bilateral Septic Cavernous Sinus Thrombosis after Facial Trauma

Sang Moon Youn; Sul Gee Lee; Jae Wook Yang

doi:10.3341/jkos.2013.54.4.662

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Youn, Lee, and Yang: A Case of Bilateral Septic Cavernous Sinus Thrombosis after Facial Trauma

Original Article

J Korean Ophthalmol Soc 2007;54(4):662-666.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.4.662

A Case of Bilateral Septic Cavernous Sinus Thrombosis after Facial Trauma

Sang Moon Youn, MD, Sul Gee Lee, MD, PhD, Jae Wook Yang, MD, PhD

Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Address reprint requests to Jae Wook Yang, MD, PhD Department of Ophthalmology, Inje University Busan Paik Hospital #75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea Tel: 82-51-890-6016, Fax: 82-51-890-6329, E-mail: eyeyang@inje.ac.kr

Received 15 June 201223 September 2012 Accepted 25 February 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

J Korean Ophthalmol Soc 2013;54(4):662-666

Keywords: Cavernous sinus thrombosis, Facial trauma, Ophthalmic vein thrombophlebitis, Trauma

References

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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).

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