Spontaneous Superior Ophthalmic Vein Thrombosis: A Case Report (P6.227)

Objective: Superior ophthalmic vein thrombosis (SOVT) is a rare entity. We report a case of SOVT in a patient without any underlying risk factors. Case: A 68-year-old white woman with a remote history of migraines, presented to the emergency department with an ongoing headache for 2 weeks. The headache was right sided, retro-orbital, throbbing, and progressively getting worse. She also had photophobia and intermittent binocular horizontal diplopia. There was no history of fever or sinus infection. Physical examination was pertinent for proptosis of the right eye; fundus, visual acuity and extra-ocular movements were normal. No sign of infection was noted on exam. Laboratory tests were unremarkable. MRI of brain with contrast revealed right SOVT. Heparin drip was initiated and bridged to Coumadin on discharge. Hypercoagulable work up sent prior to initiating anticoagulants returned unremarkable. Discussion: SOVT is a rare entity characterized by rapidly progressive orbital signs and symptoms including painful proptosis, ophthalmoplegia and periorbital edema due to blockage of venous drainage from the orbit. Painful proptosis is the most common presenting symptom. SOVT is usually found in patients with orbital congestion such as orbital cellulitis, vascular malformation, retro-orbital tumor, thyroid orbitopathy, sinus infections or sarcoid, and in patients with underlying hypercoagulability. MRI and MRV of the brain and orbit can confirm the diagnosis of SOVT and exclude other mimicking disorders. The absence of expected signal void in the superior ophthalmic vein is a sign of thrombosis. Enhanced CT scan and cerebral angiography are not very sensitive. Treatment consists of antibiotics or surgery depending on the underlying cause. In patients when no cause is identified or patients with underlying hypercoagulability, anticoagulation should be considered. Conclusion: In patients with ophthalmoplegia, painful proptosis, and periorbital edema, the diagnosis of SOVT should be considered to prevent potentially serious sequela such as cavernous sinus thrombosis. Disclosure: Dr. Singh has nothing to disclose. Dr. Gaindh has nothing to disclose. Dr. Mustafa has nothing to disclose. Dr. Kamal has nothing to disclose. Dr. Mowla has nothing to disclose.