Topic outline

  • Grand Rounds

    A patient presented to the ophthalmology emergency room with a 1 day history of periorbital edema, decreased vision, pain with extraocular movements, and diplopia. Evaluation showed proptosis with significant injection and engorged conjunctival vessels. MRI of the brain and orbits with and without contrast showed a right superior ophthalmic vein thrombosis with nonspecific fullness of the anterior right cavernous sinus. By the next morning, the patient had a significant and rapid decrease in visual acuity as well as increased intraocular pressure. A lateral canthotomy with cantholysis was performed and the patient was urgently admitted to the hospital. Extensive workup in the hospital showed no underlying infection, hypercoagulability condition, or malignancy. MRA of the head and neck as well as CTA of the head and neck showed congestion of the cavernous sinus but no definite carotid-cavernous fistula. The patient was treated with antibiotics, anticoagulation, and corticosteroids with considerable improvement in visual acuity.

    Presentation Date: 08/01/2024
    Issue Date: 08/16/2024