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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
BMJ Case Rep. 2010; 2010: bcr0820092225.
Published online Dec 3, 2010. doi:  10.1136/bcr.08.2009.2225
PMCID: PMC3028264
Reminder of important clinical lesson
Ocular manifestations of cavernous sinus thrombosis
V Visvanathan,1 S Uppal,2 and S Prowse3
1Southern General Hospital, Glasgow, UK
2Yorkshire Deanery, Leeds, UK
3Leeds General Infirmary, Leeds, UK
Correspondence to V Visvanathan, vikranth/at/
A 17-year-old male presented with a 10-day history of symptoms of upper respiratory tract infection, headaches, photophobia and progressive swelling around both eyes.
Clinical examination revealed a temperature of 39 °C and bilateral periorbital swelling which was worse on the left side. Initial ophthalmological examination revealed a dilated non-reactive pupil on the left side and a sluggish pupillary reflex on the right side.
The patient also had a lateral rectus palsy of the left eye. Fundoscopy showed bilateral papilloedema, and visual acuity on admission was 6/12 in the right and 6/18 in the left eye. Ear, nose and throat examination revealed a rhinitic nasal mucosa with thick mucopus in the left middle meatus.
The patient required surgical intervention to drain his sinuses followed by long-term intravenous antibiotic therapy and anticoagulation. After 6 weeks of therapy and close observation, he recovered with minimal sequelae.
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