Superior Ophthalmic Vein Thrombosis Induced by Orbital Cellulitis: An Ophthalmic Emergency

Lu Chen,Samy I Mcfarlane,Parag Mehta,Uta S Guo,Gennadiy Grutman

doi:10.7759/cureus.19038

Abstract

Superior ophthalmic vein thrombosis (SOVT) is a rare ophthalmologic emergency. The most common etiologies include infection, trauma, inflammation, and malignancy, as well as thyroid-related orbitopathy. Early identification and timely intervention can lead to a significant decrease in complications that include cavernous sinus thrombosis (CST), vision loss, and death. This rare disease entity almost always makes its initial presentation to internal medicine or emergency medicine (EM) physicians. In this report, we present a case of SOVT that presented overnight to the emergency department for worsening right facial swelling and orbital pain. We discuss our experience with the evaluation and management of SOVT and provide a review of the currently available literature to emphasize the importance of obtaining a full history and physical examination, seeking early imaging studies, and ophthalmology consultation for patients with suspected SOVT.

Highlights

Primary care and emergency medicine (EM) physicians serve as the initial medical contact for patients with a broad spectrum of diseases
The most commonly reported cases of Superior ophthalmic vein thrombosis (SOVT) are associated with infectious etiology of surrounding structures, such as orbital cellulitis (OC) [2,3,4,5,6,7,8], sinusitis [9,10], dental abscess [7,11], and cutaneous infection [12,13,14]
Due to the strong association with orbital cellulitis, suspicion of SOVT is high if the physical examination is suggestive of optic nerve or orbital involvement [1]

Summary

Introduction

Primary care and emergency medicine (EM) physicians serve as the initial medical contact for patients with a broad spectrum of diseases. We describe a case of OC-induced SOVT initially treated as conjunctivitis and, after further investigation, successfully managed with intravenous (IV) antibiotics and anticoagulation The purpose of this case report is to emphasize the importance of obtaining a full history with a focused physical examination, seeking early imaging studies, and ophthalmology consultation for patients with suspected SOVT. A 44-year-old male with uncontrolled diabetes mellitus (DM) type II secondary to medication noncompliance presented overnight to the emergency department for worsening right hemifacial swelling and sharp orbital pain with flu-like symptoms that started 10 days prior. He reported right-sided ocular pain but denied changes in visual acuity or color perception.

Discussion

Conclusions

Disclosures