Superior ophthalmic vein thrombosis
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Superior ophthalmic vein thrombosis is rare but can potentially lead to visual loss in the affected eye(s).
Epidemiology
Superior ophthalmic vein thrombosis is very rare, with an incidence of 3-4 cases/million/year 1. It can be either unilateral or bilateral.
Clinical presentation
Superior ophthalmic vein thrombosis may manifest as 1,2:
ptosis- painful proptosis
- conjunctival congestion
- chemosis
-
limited eye movementophthalmoplegia - visual disturbance which can progress to loss of vision
Complications are usually due to the underlying pathology 1.
Pathology
Aetiologies for superior vein thrombosis includecan be divided into septic and aseptic 1,2:
- septic aetiologies
- orbital cellulitis - most common cause
- paranasal sinusitis
- septic cavernous sinus thrombosis
- aseptic aetiologies
- facial trauma
- aseptic facial inflammation
- caroticocavernous fistula
- hypercoagulable states
- orbital neoplasm
- idiopathic orbital inflammation
- Tolosa-Hunt syndrome
Radiographic features
The modalities of choice for the diagnosis of superior ophthalmic vein thrombosis are either CT venography (CTV) and MR venography (MRV). The thrombus is directly visualised as a linear filling defect inthat dilates the vein and often extendscan extend into the ipsilateral cavernous sinus (if its origin was not the cavernous sinus, to begin with).
Treatment and prognosis
Immediate anticoagulant treatment should be instituted. Except in cases of trauma, aseptic inflammation and ABC,should be treated as wellwhere applicable.
-<p><strong>Superior ophthalmic vein thrombosis</strong> is rare but can potentially lead to visual loss in the affected eye(s).</p><h4>Epidemiology</h4><p>Superior ophthalmic vein thrombosis is very rare, with an incidence of 3-4 cases/million/year <sup>1</sup>.</p><h4>Clinical presentation</h4><p>Superior ophthalmic vein thrombosis may manifest as <sup>1,2</sup>:</p><ul>-<li><a title="Ptosis" href="/articles/ptosis">ptosis</a></li>-<li>painful <a title="Proptosis" href="/articles/proptosis-1">proptosis</a>- +<p><strong>Superior ophthalmic vein thrombosis</strong> is rare but can potentially lead to visual loss in the affected eye(s).</p><h4>Epidemiology</h4><p><a href="/articles/superior-ophthalmic-vein">Superior ophthalmic vein</a> thrombosis is very rare, with an incidence of 3-4 cases/million/year <sup>1</sup>. It can be either unilateral or bilateral.</p><h4>Clinical presentation</h4><p>Superior ophthalmic vein thrombosis may manifest as <sup>1,2</sup>:</p><ul>
- +<li>painful <a href="/articles/proptosis-1">proptosis</a>
-<li>limited eye movement</li>-<li>visual loss</li>-</ul><p>Complications are usually due to the underlying pathology <sup>1</sup>.</p><h4>Pathology</h4><p>Aetiologies for superior vein thrombosis include <sup>1,2</sup>:</p><ul>- +<li><a title="Ophthalmoplegia" href="/articles/ophthalmoplegia">ophthalmoplegia</a></li>
- +<li>visual disturbance which can progress to loss of vision</li>
- +</ul><p>Complications are usually due to the underlying pathology <sup>1</sup>.</p><h4>Pathology</h4><p>Aetiologies can be divided into septic and aseptic <sup>1,2</sup>:</p><ul>
-<a title="Orbital cellulitis" href="/articles/orbital-infection">orbital cellulitis</a> - most common cause</li>- +<a href="/articles/orbital-infection">orbital cellulitis</a> - most common cause</li>
-<li>septic <a title="Cavernous sinus thrombosis" href="/articles/cavernous-sinus-thrombosis">cavernous sinus thrombosis</a>- +<li>septic <a href="/articles/cavernous-sinus-thrombosis">cavernous sinus thrombosis</a>
-<li><a title="Caroticocavernous fistula" href="/articles/caroticocavernous-fistula-1">caroticocavernous fistula</a></li>- +<li><a href="/articles/caroticocavernous-fistula-1">caroticocavernous fistula</a></li>
- +<li><a title="Idiopathic orbital inflammation" href="/articles/idiopathic-orbital-inflammation">idiopathic orbital inflammation</a></li>
-<a title="Tolosa-Hunt syndrome" href="/articles/tolosa-hunt-syndrome-3">Tolosa-Hunt syndrome</a><ul></ul>- +<a href="/articles/tolosa-hunt-syndrome-3">Tolosa-Hunt syndrome</a><ul></ul>
-</ul><h4>Radiographic features</h4><p>The modalities of choice for the diagnosis of superior ophthalmic vein thrombosis are either CT venography (CTV) and MR venography (MRV). The thrombus is directly visualised as a linear filling defect in the vein and often extends into the ipsilateral cavernous sinus.</p><h4>Treatment and prognosis</h4><p>Immediate anticoagulant treatment should be instituted. Except in cases of trauma, aseptic inflammation and <strong>ABC</strong>, the underlying cause should be treated as well.</p>- +</ul><h4>Radiographic features</h4><p>The modalities of choice for the diagnosis of superior ophthalmic vein thrombosis are CT venography (CTV) and MR venography (MRV). The thrombus is visualised as a linear filling defect that dilates the vein and can extend into the ipsilateral <a href="/articles/cavernous-sinus">cavernous sinus</a> (if its origin was not the cavernous sinus, to begin with).</p><h4>Treatment and prognosis</h4><p>Immediate anticoagulant treatment should be instituted, as well as treatment for the underlying cause where applicable.</p>
References changed:
- 1. Sotoudeh H, Shafaat O, Aboueldahab N, Vaphiades M, Sotoudeh E, Bernstock J. Superior ophthalmic vein thrombosis: What radiologist and clinician must know?. (2019) European journal of radiology open. 6: 258-264. <a href="https://doi.org/10.1016/j.ejro.2019.07.002">doi:10.1016/j.ejro.2019.07.002</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31641683">Pubmed</a> <span class="ref_v4"></span>
- 2. Nicolien A. van der Poel, Kornelis D. de Witt, René van den Berg, Maartje M. de Win, Maarten P. Mourits. Impact of superior ophthalmic vein thrombosis: a case series and literature review. (2018) Orbit. 38 (3): 226-232. <a href="https://doi.org/10.1080/01676830.2018.1497068">doi:10.1080/01676830.2018.1497068</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30040506">Pubmed</a> <span class="ref_v4"></span>
Systems changed:
- Head & Neck
Images Changes:
Image 1 CT (C+ portal venous phase) ( create )
Image 2 MRI (T1 C+) ( create )
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