Superior ophthalmic vein thrombosis: What radiologist and clinician must know?

Abstract

Superior ophthalmic vein thrombosis (SOVT) is an extremely rare condition. Few studies have been published about clinical aspects of this condition. In this study, we have studied the symptoms, underlying etiologies, treatment, pathogenesis and complication of the SOVT and we tried to classify it based on the etiology, treatment, and prognosis. Methods: We reviewed the patients' data from a tertiary academic referral center. Each patient with SOVT was then reviewed for symptoms associated with SOVT, underlying etiology, treatment protocol, treatment response, complications, possible pathogens, and final outcome. Results: Twenty-four cases of SOVT were included in this study. Overall, 13 cases were diagnosed as right-sided SOVT, out of which, eight had simultaneous right-sided cavernous sinus thrombosis (CST). Eighteen cases were diagnosed to have left-sided SOVT, out of which, 11 had simultaneous left-sided CST. Conclusions: The SOVT can be secondary to different mechanisms. The SOVT secondary to trauma, recent surgery and coagulopathy are mostly non-aggressive, and can be managed by conservative therapy and anticoagulation. The SOVT in patients with orbital cellulitis, history of active sinusitis or paranasal sinus surgery are aggressive presenting with acute orbital swelling, abscess and visual loss. This type of SOVT can be complicated by extension to the cavernous sinus and intracranial structures. These patients require urgent antibiotics therapy and sinus surgery. The most severe type of SOVT is caused by mucormycosis which may also extend intracranially resulting in stroke and is often life-threatening.

Superior ophthalmic vein thrombosis secondary to COVID-19: an index case

“… [12] [13] Its etiology can be categorized into septic and aseptic causes, orbital cellulitis being the most commonly associated condition. [3] [14] It can also present either unilaterally or bilaterally and has an association with cavernous sinus thrombosis. The signs and symptoms of SOV thrombosis are usually due to impaired venous drainage from the affected orbit e.g.…”

“…The primary findings include a dilated SOV with linear filling defects on CT or MRI venography or affected vessel hyperdensity in non-contrast examinations. [3] …”

“…Septic SOV thrombi, secondary to orbital cellulitis or paranasal sinusitis, have a higher risk of complications such as abscess formation and therefore are likely to require surgical intervention and drainage. [3] …”

“…Orbital cellulitis, sinusitis and septic cavernous sinus thrombosis account for common primary septic causes whereas facial trauma, hypercoagulability, aseptic inflammation, orbital neoplasms and Tolosa-Hunt syndrome account for the aseptic etiologies. [3] [4] . The clinical features of SOV thrombosis can include painful proptosis, chemosis, conjunctival swelling, ophthalmoplegia, trismus and visual disturbance/loss.…”

Imaging of Paranasal Sinus Infections in Children: A Review

“…SOVT may manifest as painful proptosis, conjunctival congestion, chemosis, ophthalmoplegia, and visual disturbances which can progress to loss of vision. Underlying causes may be classified as septic (orbital cellulitis, ARS, and CST) or aseptic (trauma, recent surgery, coagulopathy, orbital neoplasms, Tolosa‐Hunt syndrome) 76 . Neuroimaging is essential in the diagnosis (Figs 1 and 3), particularly MR venography and DWI‐ADC will provide additional information.…”