A patient with sinus infection develops chemosis, B/L proptosis and fever, the diagnosis goes in or of:
Angular vein which begins from medial angle of eye, continues as the facial vein. The facial vein communicates with the cavernous sinus through the deep facial vein and pterygoid plexus of veins. Cavernous SINUS INFECTION Route of Spread Ethmoid sinus (most common) ophthalmic veins Sphenoid sinus by direct spread. Frontal sinus supraorbital and ophthalmic veins. Orbit by ophthalmic veins. Upper lid Angular vein and ophthalmic veins. Ear by petrosal venous sinuses. Clinical Features Onset is abrupt with fever, chills and rigor It is bilateral Involvement of IlIrd, IVth, Vth and Vith cranial nerves Chemosis of conjunctiva Proptosis of the eye with limited movements Papilledema Pupils are dilated and fixed Decreased vision Decreased sensation in distribution of Vth nerve (ophthalmic division) Progressive ophthalmoplegia (specially for lateral gaze) Treatment It is a life-threatening condition. Antibiotics are given in high doses for 4-6 weeks. The incidence of all orbital complications including cavernous sinus thrombosis are common in pediatric age group. Visual problems are present from stage III onward of orbital cellulitis i.e. from stage of abscess formation. Orbital complications are almost always secondary to ethmoid rhinosinusitis but may occur with frontal rhinosinusitis also.
Lateral sinus thrombosis
Frontal lobe abscess
Cavernous sinus thrombosis
Meningtitis