Superior ophthalmic vein thrombosis in a patient with dacryocystitis-induced orbital cellulitis.
A 71-year-old-man presented with chronic left-sided epiphora and a 5-day history of progressive left orbital swelling that had started with a "bump" on the left side of his nose. Orbital CT revealed left-sided preseptal and postseptal inflammation, along with marked thickening of the left superior ophthalmic vein. Orbital MRI with gadolinium enhancement and fat suppression revealed a low-intensity signal in the left superior ophthalmic vein, consistent with a superior ophthalmic vein thrombosis. There was no cavernous sinus involvement. A diagnosis was made of left-sided dacryocystitis-induced orbital cellulitis and superior ophthalmic vein thrombosis. Treatment consisted of intravenous vancomycin, followed by early dacryocystorhinostomy and postoperative intravenous dexamethasone. Anticoagulation was not used. Within 1 week after surgery, the orbital congestion had dramatically improved. Though rare, isolated superior ophthalmic vein thrombosis can be a harbinger of cavernous sinus thrombosis; therefore, early detection is the key to avoiding cavernous sinus thrombosis.
Schmitt
Nicholas J
NJ
Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA. nschmitt68@yahoo.com
Beatty
Randall L
RL
Kennerdell
John S
JS
D000368:Aged; D002481:Cellulitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003131:Combined Modality Therapy; D003607:Dacryocystitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003608:Dacryocystorhinostomy; D003907:Dexamethasone / Q000627:therapeutic use; D005123:Eye / Q000098:blood supply; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009916:Orbital Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014640:Vancomycin / Q000627:therapeutic use; D014680:Veins; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
D014640:Vancomycin; D003907:Dexamethasone