Presentation
Acute onset of left orbital pain and difficulty in opening left eye since 2 days.
Patient Data
There is inflammatory edema in left periorbital & left intraorbital regions with involvement of conal, intraconal and extraconal spaces - representing orbital cellulitis. There is mild axial proptosis of left eye globe.
STIR hyperintense signals are seen in left optic nerve with restricted diffusion - representing acute optic neuritis.
There is loss of flow void in left superior ophthalmic vein with absent flow signals on venogram –representing thrombosis.
Right eye globe appears normal.
Mild mucosal thickening is seen involving bilateral maxillary, ethmoid, sphenoid and frontal sinuses – representing mild sinusitis.
Small T1 hyperintense retention cysts are seen in right sphenoid sinus and left middle ethmoid sinus.
Case Discussion
Superior ophthalmic vein thrombosis is usually secondary to orbital infections, generalized hypercoagulable states or orbital mass lesions. High index of suspicion and early imaging with MRI orbits with venogram or CT venogram will help in early diagnosis of superior ophthalmic vein thrombosis.
Orbital cellulitis can be primary or secondary to adjacent paranasal sinus infections.
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