Superior Ophthalmic Vein Thrombosis from Orbital Cellulitis in Setting of Trauma

The diagnosis of superior ophthalmic vein thrombosis (SOVT) should be considered in patients who present with painful proptosis, chemosis, periorbital edema, and ophthalmoplegia. Early diagnosis and treatment is crucial to prevent SOVT progression to cavernous sinus thrombosis (CST), which can lead to neurologic deterioration, blindness, or death. It is assessed by imaging, preferably via CT scan or MRI. Both septic and aseptic causes have been implicated in SOVT. The most common cause of septic SOVT is sinusitis, but can also involve other infections of the orbits, teeth, and face. Aseptic causes include anatomic constraints, inflammatory conditions, hematologic abnormalities, and trauma. Once the etiology is determined, the patient can be managed appropriately. If infectious, broad-spectrum antibiotics should be administered. Systemic anticoagulation is recommended, as it not only prevents, but also reduces mortality in CST. Currently, there is not enough data supporting the role of steroids in SOVT. Surgery is indicated when there is an underlying source of infection, such as an abscess, that can be drained.