Overview Thrombophlebitis of the spongy sinus is a very serious disease with a high mortality rate, which has been reduced since the use of antibiotics. EtiologyThe spongy sinus is not a simple venous channel, but consists of trabecular structures surrounded by dura mater. In it, there are large arteries and interlocking veins, which makes blood flow and drainage more difficult. It receives most of the return blood from the ophthalmic veins and at its posterior end is connected to the jugular plexus, rocky sinus and pterygoid plexus. Since facial (including eye and nasal) veins have no venous valves, any infection or germs can pass through the venous reflux and stay in the cavernous sinus, slowing down the blood flow, and sometimes the infected blood clot enters the cavernous sinus and causes edema of the endothelial cells of the curved veins, thus forming a thrombus containing streptococcus or staphylococcus aureus. It is common for: 1) boils on the face, lips, head, eyes, throat and other tissues to metastasize via hematopoiesis; 2) orbital crestal fossa weaving extending backward to the cavernous sinus; 3) infections of other tissues such as mastoiditis and paranasal sinusitis to the cavernous sinus via the lateral sinus or hematopoiesis. The onset of the disease is rapid and dangerous: 1. the lesion starts unilaterally, with severe headache in the forehead and painful hyperalgesia in the trigeminal nerve distribution area; 2. eyelid edema, conjunctival congestion and edema, intraorbital infiltration, and abscess formation; 3. congestion and redness of the nasal root; 4. the eye protrudes significantly, without pain on rotation; 5. the third, fourth, and sixth cranial nerves (i.e., the motoneurotic, talocrural, and abducens nerves) are paralyzed, and eye movements are 6. Funduscopic examination shows dilated and congested retinal veins and edema of the optic nerve papillae; 7. If the pus embolus flows into the jugular vein, it can cause pulmonary embolism, chest pain, pneumonia or pleurisy. Diagnosis based on 1. Severe systemic toxicity symptoms; 2. Protrusion of the eyeballs bilaterally is obvious, and the eyelids and conjunctiva are congested and edematous. Early appearance of III, IV and VI cranial nerve palsy, fundus retinal vein congestion and optic disc edema, etc.; 3, positive meningeal irritation sign; 4, leukocytosis in cerebrospinal fluid, culture with streptococcus or Staphylococcus aureus. The differential diagnosis is mainly orbital cellulitis: normal pupil-to-light reflex, no optic disc edema, and severe pain. Treatment Once the diagnosis is clear, immediate intravenous high-dose application of methylpenicillin or penicillin G, gentamicin and, if necessary, cephalosporin I. Sulfonamide preparations can be combined. Then adjust antibiotics according to bacterial culture and drug sensitivity results. When signs and symptoms of increased intracranial pressure appear, dehydrating drugs such as mannitol need to be applied to reduce intracranial pressure to avoid brain herniation formation. Close contact with the neurologist or internist, closely observe the vital signs and changes in consciousness. After active treatment, most patients are saved and can retain some vision. Topical drops of 0.25% chloramphenicol eye drops or 0.3% gentamicin eye drops are applied to the eyes, and wet compresses are applied to protect the eyeballs bilaterally.