title: Ophthalmic manifestations and outcomes after cavernous sinus thrombosis in children.
abstract: OBJECTIVE
  To review the causes, treatment, and outcomes of cavernous sinus thrombosis (CST) in children.
  
  
  METHODS
  The medical records of children (<18 years of age) diagnosed with thrombophlebitis of an intracranial venous sinus were reviewed to identify cases of CST presenting to Children's Hospital Colorado from January 2000 through January 2013. Cases were evaluated for etiology, symptoms, imaging characteristics, treatment, and outcomes.
  
  
  RESULTS
  A total of 110 children with a venous thrombus of an intracranial sinus were included. Of these, 9 had a CST. All cases were confirmed by magnetic resonance imaging. All 9 had sinusitis, 4 had orbital involvement, and 1 resulted from a nasal septal abscess. Eight cases presented with ophthalmoplegia, and 5 presented with decreased vision. Every patient underwent sinus surgery: 4 underwent orbitotomy for abscess drainage, and 1 required bilateral exenteration. Cultures were inconclusive in 2 cases, and 2 cases were culture positive rhino-orbital mucormycosis. There was 1 case of methicillin-resistant Staphylococcus aureus. Of the 9 cases, 4 returned to normal vision and ocular motility; 5 had permanent ophthalmoplegia and vision loss. There were no cases of mortality.
  
  
  CONCLUSIONS
  CST is a rare complication of orbital and sinus disease. High clinical suspicion, early neurologic imaging, and a multidisciplinary approach to management are key factors in reducing morbidity and mortality from CST in children.
authors.affiliation: Oculoplastic and Orbital Surgery, Department of Ophthalmology, University of Colorado Hospital, Aurora.
authors.forename: Garett S
authors.initials: GS
authors.lastname: Frank
authors.affiliation: Oculoplastic and Orbital Surgery, Department of Ophthalmology, University of Colorado Hospital, Aurora.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Smith
authors.affiliation: Oculoplastic and Orbital Surgery, Department of Ophthalmology, University of Colorado Hospital, Aurora; Oculoplastic and Orbital Surgery, Department of Ophthalmology, San Antonio; Military Medical Center/Wilford Hall, San Antonio, Texas.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Davies
authors.affiliation: Department of Radiology, Childrens Hospital Colorado, University of Colorado School of Medicine, Aurora.
authors.forename: David M
authors.initials: DM
authors.lastname: Mirsky
authors.affiliation: Oculoplastic and Orbital Surgery, Department of Ophthalmology, University of Colorado Hospital, Aurora.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Hink
authors.affiliation: Oculoplastic and Orbital Surgery, Department of Ophthalmology, University of Colorado Hospital, Aurora; Department of Otolaryngology-Head and Neck Surgery, University of Colorado Hospital, Aurora; Texas Oculoplastic Consultants, Austin, Texas. Electronic address: vdurairaj@tocaustin.com.
authors.forename: Vikram D
authors.initials: VD
authors.lastname: Durairaj
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020226:Cavernous Sinus Thrombosis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D002648:Child; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D009091:Mucormycosis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D013508:Ophthalmologic Surgical Procedures; D054517:Orbital Cellulitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D012852:Sinusitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents