OpenHealth Q&A

Concerns Regarding Cavernous Sinus Thrombosis

I am a 29-year-old female with a medical history of Hashimoto’s thyroiditis, for which I take 88 micrograms of levothyroxine. Aside from that, I am generally in good health. On March 6th, I experienced an upper respiratory infection, which I presumed was COVID-19 due to a loss of taste and smell lasting ten days, although I did not undergo testing. By day six, I was starting to feel better, but congestion lingered until approximately day ten. Then on March 16th, I began to notice sudden sinus pressure, a runny nose producing yellow-green mucus, sharp pain radiating from behind my right eye, and discomfort around my jaw. I sought care at a walk-in clinic, where I was given a prescription for Augmentin for a week, suspecting bacterial sinusitis. The following day, the pressure intensified beneath my right eye, accompanied by noticeable redness and a drooping eyelid. There were no changes to my vision. After several hours, the pain lessened, prompting me to leave the ER after a two-hour wait because I felt better. On March 19th, the severe pressure and droopiness returned, so I visited urgent care again. A CT scan with contrast revealed extensive opacification of all my sinuses on both sides. The medical team advised me to use Flonase and Afrin; however, these did not alleviate the congestion, though the eye pain became intermittent over subsequent days, so I continued as instructed. By March 25th, I remained congested, and my right eye still appeared droopy compared to my left. My primary care physician then prescribed a five-day course of prednisone. On March 30th, I noticed some improvement from the prednisone over the previous days. Although I still had congestion, it did not hinder my daily activities. However, on my first day off prednisone, the pressure in my forehead and eye returned. The next day, March 31st, my eye swelled again, appearing red, and the pain intensified. I returned to urgent care, where another CT scan indicated that the sinuses on my right side were still largely opacified. While an initial reading indicated the presence of an abscess near my right eye, a later evaluation by an attending radiologist concluded this was merely stranding in the interconal fat. I was diagnosed with sepsis due to abnormal lab results, including elevated leukocytes and tachycardia (resting heart rate of 103 bpm), along with periorbital cellulitis. I was admitted to the hospital and treated with IV Unasyn and Vancomycin, with a recommendation for both ophthalmology and ENT consultations. April 1st came, and while I did not receive an ENT consult, I saw the eye doctor who cleared me and unexpectedly discharged me without finishing the IV Vancomycin infusions. The nurse was also surprised by the discharge decision, as there was no discussion of the sinusitis or any potential abscess. I left with a twelve-day supply of Augmentin and an ENT appointment set for May 1st. Although my leukocyte and neutrophil counts normalized, my CRP level remained elevated at 23.3 mg/L upon discharge. As of today, my right eye continues to appear slightly droopy compared to my left, and I feel pressure in my forehead, especially above and behind my right eye. This pressure does not cause pain, but it resembles the sensation one gets when leaning upside down. The treatment plan I received does not give me much reassurance, and I am increasingly worried about the persistent droopiness and pressure. I am especially concerned that my symptoms may align with cavernous sinus thrombosis, particularly considering the intermittent swelling and pain in my eye that I experienced. While I have not felt pain since March 31st, I still detect noticeable pressure and occasional sharp pains above my right eyebrow. The radiologist mentioned that I have patterns of obstruction in my right side sinuses, which raises my concern that without an ENT consultation, my issues may persist or worsen. I have a follow-up appointment with my primary care physician scheduled for April 8th. Should I wait until this appointment, or would it be wise to seek earlier medical attention? Thank you for your input!

Answers (1)

4/4/2025, 3:01:11 PM

OpenHealth AI

Your ongoing symptoms, particularly the droopiness of your right eyelid and the pressure you feel, can understandably be concerning. The possibility of cavernous sinus thrombosis (CST) is serious but it’s important to approach this carefully and rationally.

Main Points

1. Cavernous Sinus Thrombosis (CST) Considerations: While CST can be a complication of sinus infections, it's crucial to evaluate your symptoms as a whole.
2. Monitoring Symptoms: You need to keep an eye on any changes, especially in eye symptoms, vision, or the severity of your forehead pressure.
3. Immediate Guidance: It’s advisable to seek medical evaluation sooner than your scheduled April 8th appointment, particularly with your recent history of periorbital cellulitis and your ongoing symptoms.

Explanation

• Cavernous Sinus Thrombosis and Sinusitis Connection: CST can occur when infections from the sinuses spread. Symptoms include severe headache, fever, ophthalmic symptoms (like drooping eyelids), and neurological changes.
• Infection and Inflammation: Your previous diagnosis of sepsis and periorbital cellulitis shows you have had significant inflammation and infection, which necessitates careful monitoring.
• Importance of Timely Care: Given your history and current symptoms (including eyelid droop and forehead pressure), a follow-up with an ENT specialist can help evaluate the situation comprehensively.

Next Steps

1. Seek Medical Attention Sooner: Contact your healthcare provider or an urgent care facility to express your concerns about possible CST and persistent symptoms. They may want to conduct further imaging or evaluations based on your history.
2. Monitor Symptoms Closely: Keep a log of your symptoms, especially any changes in the appearance of your eyelid, vision issues, or increasing forehead pressure.
3. Avoid Delays in Care: If you notice new symptoms such as severe headache, sudden changes in vision, or worsening of your current symptoms, consider going to the emergency room immediately.

In the meantime, continue taking care of yourself through adequate hydration and rest. This situation can feel overwhelming, but ensuring you have the right healthcare support and continuous monitoring is essential. Please keep me updated on your situation, and I'm here to offer guidance along the way.