Rare but severe acute clinical syndrome in which the spaces of the cavernous sinus posterior to the orbital cavity become thrombosed, usually in the presence of adjacent purulent processes. This is not an orbital disorder in the strict sense.
Etiology: These are purulent inflammations that have spread from the middle ear, petrous bone, orbital cavities, or from the facial skin via the angular vein.
Symptoms: Patients present with an acute clinical picture with headache, stupor, fever, and vomiting.
Clinical findings: The ophthalmologist will usually diagnose bilateral exophthalmos and episcleral and conjunctival venous stasis in combination with multiple pareses of the cranial nerves. Neurogenic paralysis of all ocular muscles is referred to as total ophthalmoplegia. Where the optic nerve is also involved, the condition is referred to as orbital apex syndrome.
U The limited motility of the globe is primarily neurogenic and due to damage to the nerves in the cavernous sinus as opposed to the mechanical limitation of motility due to the orbital inflammation in orbital cellulitis.
Diagnostic considerations and treatment: This lies primarily in the hands of ENT specialists, neurosurgeons, and internists. High-dose systemic antibiotic therapy and anticoagulation are indicated.
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