Summary

• Thrombus formation within the cavernous sinus, which may be either septic or aseptic in origin. Infection can spread to the cavernous sinus either as an extension of thrombophlebitis or by septic emboli. The origin of aseptic cavernous sinus thrombosis is usually trauma, injury, or a prothrombotic condition.
• In the pre-antibiotic era, infections of the middle third of the face were responsible for the majority of cases. Currently, the most common cause is as a complication of acute sinusitis.
• Diagnosis is usually made through clinical evaluation together with imaging (CT or MRI).
• In the acute presentation, one eye is typically affected first, followed by the second eye within 48 hours of symptom onset.
• Must be differentiated from meningitis. Common early clinical features of both conditions include fever, headache, vomiting, and nuchal rigidity.
• Antibiotics should be started immediately because they have the greatest effect on prognosis.