J Korean Ophthalmol Soc.  2005 Apr;46(4):731-735.

A Case of Bilateral Cavernous Sinus Thrombosis with Intraorbital Abscess

• Koo NK
• Kim JH
• Lee SY

Abstract

PURPOSE
We report a case of bilateral cavernous sinus thrombosis and unilateral intraorbital abscess in a patient suffering proptosis, a limitation of ocular movement, and visual disturbance. METHODS: After several days of febrile and chilling sensation, a 49-year-old man suffered from vision loss, a limitation of ocular movement in all directions, proptosis in the right eye and mild abduction limitation in the left eye. Brain MRI, indicated inflammation in the bilateral cavernous sinuses and intraorbital abscess in the right eye, leading to a diagnosis of cavernous sinus thrombosis. Systemically, the patient was treated with antibiotics and steroid injection. For intraorbital abscess, aspiration and antibiotics injection were administered locally. The patient improved overall and the abscess size decreased. Blood culture showed alpha-hemolytic Streptococcus. The Gram stain of the specimen from the intraorbital abscess revealed Gram-positive cocci but no specific strain was cultured. RESULTS: We believe that proptosis in the right eye, intraorbital abscess, limitation of ocular movement, retinal hemorrhage, and optic atrophy were due to alpha-hemolytic Streptococcus, which had spread to the cavernous sinus and right orbit through the vascular system. CONCLUSIONS: We report a case of bilateral cavernous sinus thrombosis and intraorbital abscess in the right eye in a patient who suffered from sepsis caused by alpha-hemolytic Streptococcus.

Keyword

alpha-hemolytic Streptococcus; Cavernous sinus thrombosis; Intraorbital abscess

MeSH Terms

Abscess*
Anti-Bacterial Agents
Brain
Cavernous Sinus Thrombosis*
Cavernous Sinus*
Diagnosis
Exophthalmos
Gram-Positive Cocci
Humans
Inflammation
Magnetic Resonance Imaging
Middle Aged
Optic Atrophy
Orbit
Retinal Hemorrhage
Sensation
Sepsis
Streptococcus
Anti-Bacterial Agents