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Asymmetric Superior Ophthalmic Vein Thrombosis due to Sepsis Induced by a Deep Neck Infection

Jungyong Kim and Sungmo Kang

Superior ophthalmic vein thrombosis is one of the early signs of cavernous sinus thrombosis. It is characterized by ipsilateral proptosis, ptosis, chemosis, limitations of ocular muscle movement and normal fundus findings. In this article, we present a case of bilateral asymmetric superior ophthalmic vein thrombosis due to sepsis developed from a deep neck infection from a parotid gland abscess. A 49-year-old male patient presented to our emergency department with a history of progressive left neck swelling, ocular pain and conjunctival injection, ptosis, proptosis, and diplopia on his right eye. He had limitations of his extraocular muscle movement in all directions of his right eye, especially abduction and adduction limitations with no midline crossing. It was revealed that the patient was in a septic condition at the emergency department. The findings revealed a diffuse parotid gland abscess and left external carotid vein thrombosis. An incision was performed and drainage was done on next day of the ER visit. His bilateral cavernous sinus yielded a decreased enhancement on the CT scan signifying thrombophlebitis. His right superior ophthalmic vein was filled with a thrombus. The left superior ophthalmic vein was also filled with a thrombus. An orbital MRI also revealed both an ophthalmic vein engorgement due to the thrombus and an enhancement around the extraocular muscle with infiltration. A blood culture test concluded the presence of Staphilococcus auerus, a gram positive microorganism. The patient was maintained on intravenous antibiotics over his admission. After discharge, the proptosis and limited motion of the extraocular muscle dissipated. However, diplopia at the primary position remained. Septic thrombosis of the cavernous sinus is rare but a potentially detrimental condition that demands careful consideration and suspicion when dealing with a patient with an acute neck inflammation. Early recognition and prompt administration of broad spectrum intravenous antibiotics is important because isolated septic superior ophthalmic vein thrombosis is rare.