DR. MITHUN THULASIDAS

DR. AJITA SASIDHARAN, DR.SHRUTHI TARA, DR. PRADEEP BALAM

Abstract

A 58-year-old woman presented with redness in LE associated with mild pain and unilateral headache for 6 months. She was orthophoric and ocular movements were full and free. A mild axial proptosis was noted in LE. CDVA was 6/6 in RE and 6/9 in LE. IOP was 14mmHg in RE and 30mmHg in LE with open angles and no blood in Schlemm’s canal on gonioscopy. The posterior segment examination was within normal limits. A detailed glaucoma workup revealed a reduced GCC thickness, CCT of 482μ, and a less reliable visual field (after repeated testing) in LE. MRI of brain with orbit and DSA showed reduced enhancement of left cavernous sinus with inflammatory changes at maxillary, ethmoid, and frontal sinuses, suggestive of cavernous sinus thrombosis. The patient was started on systemic antibiotics and topical timolol maleate 0.5% BID in LE. At 1-week follow-up, IOP reduced to 22mmHg, and headache subsided. Possible differential diagnoses include idiopathic Radius-Maumunee syndrome and low grade CCF.