A Case of Bilateral Septic Cavernous Sinus Thrombosis after Facial Trauma

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.