Walsh & Hoyt: Superior Ophthalmic Vein Occlusion

The most common setting in which thrombosis of the superior ophthalmic vein (SOV) occurs is when a dural fistula of the cavernous sinus spontaneously closes. In this setting, a patient who may have had only mild proptosis, chemosis, and injection of the affected eye suddenly develops a worsening clinical picture characterized by increasing orbital signs accompanied by worsening of diplopia. Color Doppler imaging in such patients reveals occlusion of the SOV. Ocular pulse amplitudes in such patients gradually become reduced on the side of the fistula, indicating reduction in backflow of arterial blood through the venous system, and MR imaging shows complete or partial thrombosis of the superior ophthalmic vein. The condition is self-limited, and the patient usually begins to improve within several days. Systemic corticosteroids may be useful in hastening improvement, but they are not needed unless orbital congestion is particularly severe, and intraocular pressure is significantly elevated. Topical antiglaucoma medications, particularly carbonic anhydrase inhibitors, should be used to lower intraocular pressure and prevent retinal arterial occlusion.