It is a unilateral muscular paralysis, which begins with the external ocular motor muscle, progressive, and is accompanied by pain in the territory of the ophthalmic nerve. It is due to the injury of the motor nerves of the eye and the ophthalmic nerve in the external wall of the cavernous sinus, due to the action of a pituitary tumor, a phlebitis of the cavernous sinus or an aneurysm of the internal carotid artery, inside the breast.
Treatment: High dose intravenous antibiotics, nafcillin or oxacillin 1 to 2 g every 4 to 6 hours combined with a third-generation cephalosporin. In regions where methicillin-resistant S. aureus is prevalent, nafcillin or oxacillin should be replaced with vancomycin 1 g IV every 12 hours. An anaerobic drug (e.g., metronidazole 500 mg every 8 hours) should be added if there is an underlying dental infection or sinusitis. In cases with sphenoid sinusitis, surgical drainage is indicated, especially if there is no clinical response to antibiotics within 24 hours. Secondary treatment for cavernous sinus thrombosis may include corticosteroids (e.g., dexamethasone 10 mg PO every 6 hours).