Spontaneous superior ophthalmic vein thrombosis: a rare entity with potentially devastating consequences

Lim, Lee Hooi; Scawn, Richard; Whipple, Katherine M.; Oh, Sangjun; Lucarelli, Mark J.; Korn, Bobby S.; Kikkawa, DonO

doi:10.1038/eye.2013.273

Cited by 55 publications

(61 citation statements)

References 9 publications

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“…Patients with superior ophthalmic vein thrombosis may present with orbital pain and swelling, decreased vision, chemosis, proptosis, and cranial nerve palsy. Superior ophthalmic vein thrombosis may progress to cavernous sinus thrombosis, or both conditions may occur at the same time with similar clinical manifestations (37,38). Contrast-enhanced MR imaging and MR venography are more sensitive in the early stage of disease, which may be missed at CT.…”

Section: Superior Ophthalmic Vein Thrombosismentioning

confidence: 97%

“…Imaging findings include a dilated nonopacified superior ophthalmic vein, often with associated enlargement of the cavernous sinus, congestion of the orbital soft tissues, and proptosis (Fig 18) (5,37). Treatment depends on the underlying cause and may consist of intravenous antibiotics, anticoagulation therapy, and possible surgical intervention with drainage of orbital abscess or sinus disease (37,38).…”

Section: Superior Ophthalmic Vein Thrombosismentioning

confidence: 98%

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Demystifying Orbital Emergencies: A Pictorial Review

et al. 2017

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Imaging of the orbit plays an important role in the workup of orbital emergencies. Orbital imaging is particularly useful in the emergency department, where clinical history and physical examination may be limited or delayed until the exclusion or treatment of more life-threatening conditions. Cross-sectional orbital imaging with multidetector computed tomography (CT) and magnetic resonance (MR) imaging is commonly performed in addition to ultrasonography. In an emergent setting, CT is the preferred modality when evaluating for intraorbital foreign bodies, fractures, or calcifications within a mass lesion. MR imaging is typically the modality of choice for orbital pathologic conditions, owing to its superior ability to delineate the orbital soft tissues and visual pathways. CT and MR imaging together may supplement clinical evaluation by helping establish an accurate diagnosis, providing an objective assessment of disease extent and progression, and assisting in pretreatment planning. Orbital emergencies have a spectrum of cross-sectional imaging findings in four major categories: infection, trauma, vascular disease, and inflammation. Use of a systematic approach to these entities will assist the radiologist with identifying immediate threats to vision and thereby facilitate prompt clinical management. Familiarity with the clinical presentations also improves the radiologist's diagnostic confidence and role in guiding patient care. This article reviews imaging protocols, relevant orbital anatomy, the role of CT and MR imaging, and key imaging findings of orbital emergencies that the radiologist must know. RSNA, 2017.

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Section: Superior Ophthalmic Vein Thrombosismentioning

confidence: 97%

Section: Superior Ophthalmic Vein Thrombosismentioning

confidence: 98%

Demystifying Orbital Emergencies: A Pictorial Review

et al. 2017

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“…A multidisciplinary approach with the treating physician, neurologist, radiologist and ophthalmologist is suggested when managing a case of orbital vein thrombosis. MRI and MRV is the imaging modality of choice for confirming SOVT and can help to exclude other disorders which may mimic the condition [1,5,7].…”

Section: Resultsmentioning

confidence: 99%

“…Remote sources of infective emboli such as bacterial endocarditis should also be explored. The role of anticoagulation therapy in isolated SOVT is unclear and is considered after risk benefit analysis [5]. However, SOVT that is not treated with anticoagulation may progress to cavernous sinus thrombosis and if there is no contraindication, anti coagulant therapy can be initiated by the physician/ internist.…”

Section: Managementmentioning

confidence: 99%

“…Laboratory investigation should include a complete blood count looking for leukocytosis or left shift, an increase in the ratio of immature to mature leukocytes. If there are no signs of infection or inflammation, evaluation for a hypercoagulable condition may be indicated, including factor V Leiden, prothrombin gene mutation, lupus anticoagulant, and antithrombin III [1,5].…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

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Superior Ophthalmic Vein Thrombosis Associated with Orbital Inflammation

Pawar¹

2017

AOVS

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We report a case of a 71 year old female who presented with redness, pain and periocular swelling in the left eye of 3 months duration and decreased vision and protrusion since 15 days. Previous ophthalmological history was unremarkable. The vision was PL negative. Examination showed moderate axial proptosis, mild ptosis, fullness of the eyelids, and a chemosed, prolapsed conjunctiva. Fundus examination showed a branch vein occlusion of the inferotemporal vein. There was total ophthalmoplegia OS. A provisional diagnosis of pseudotumour was made after basic investigations, and steroid therapy was initiated, but the patient showed little response. CT orbit showed left eye proptosis with minimal fat stranding and superior ophthalmic vein thrombosis which was confirmed by MRI. She also had an intracranial infarct which was picked up on MRI. Due to multiple vaso occlusive sites, and the lack of response to steroid therapy, she was referred for a haematological work up. Superior ophthalmic vein thrombosis, although rare, can be a harbinger of cavernous sinus thrombosis, hence the need for an urgent and detailed evaluation of orbital thrombosis.

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