Superior Ophthalmic Vein Thrombosis: The Role of Anticoagulation

To report a case of superior ophthalmic vein thrombosis (SOVT) and review the available literature to assess if anticoagulation is warranted in all cases of SOVT.

The patient presented to an outside hospital facility with a severe headache involving the left frontal temporal area. This progressed to left-sided ptosis and facial droop. Magnetic resonance imaging revealed a left SOVT secondary to sphenoid sinusitis. Treatment was initiated with vancomycin and cefepime, and the patient was transferred to our tertiary care center for further management. Upon arrival at our facility, her symptoms had significantly improved compared to prior documented findings.

Due to the rarity of SOVT, large clinical studies assessing the necessity of anticoagulation are not likely to be conducted. A review of the literature suggests the use of anticoagulation is determined on a case-by-case basis, taking into account symptom severity. Our case demonstrates that a resolution of symptoms is possible without anticoagulation. The decision to initiate anticoagulation will continue to require a clinician to perform a detailed physical examination to determine if the patient is responding to antibiotic treatment alone.