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A 57-year-old man with leukocytosis and sphenoid sinus disease
Digital Journal of Ophthalmology 2020
Volume 26, Number 2
April 24, 2020
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Ansuya P. Deosaran, MD | Department of Ophthalmology, Louisiana State University, New Orleans, Louisiana
Ahmaida Zeglam, MD | Department of Ophthalmology, University of Florida, Gainesville, Florida
Mary K. Wilson, BS | College of Medicine, University of Florida, Gainesville, Florida
Andres Gonzalez, MD | Department of Ophthalmology, University of Florida, Gainesville, Florida
Matthew J. Gray, MD | Department of Ophthalmology, University of Florida, Gainesville, Florida
Examination
On examination at our institution, visual acuity was no light perception in the right eye and 20/30 in the left eye. Intraocular pressure (IOP) was 25 mm Hg in the right eye and 15 mm Hg in the left eye. The right pupil was 5 mm and nonreactive, with a relative afferent pupillary defect by reverse testing due to lack of light perception in that eye. Extraocular motility in the right eye was nonexistent. Anterior segment examination of the right eye revealed proptosis, complete ptosis, and chemosis. Dilated fundus examination of the right eye revealed disc pallor, with blurred disc margins, macular cherry red spot, attenuated vasculature, and a pale, ischemic retina. Findings suggested a possible cavernous sinus thrombosis from infection. Examination of the left eye was unremarkable.

Three days after his initial admission, the proptosis worsened, and the IOP increased to 45 mm Hg in the right eye. The following day, the left eye had new proptosis, decreased visual acuity (20/60), and an increase in IOP to 22 mm Hg. Extraocular motility of the left eye appeared restricted in all gazes. Anterior examination revealed proptosis, ptosis, and chemosis. Dilated fundus examination remained normal.

Five days after admission, visual acuity in the left eye also progressed to no light perception. His pupil was fixed at 5 mm and nonreactive. Extraocular motility was nonexistent. He developed neck stiffness, left lower extremity and forehead numbness, and intermittent confusion.
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