Successful management of cavernous sinus thrombosis without anticoagulation: a neuro-ophthalmologic case report

Cavernous sinus thrombosis (CST) is a rare and life-threatening neuro-ophthalmologic emergency. The role of adjunctive anticoagulation in infection-driven CST-especially when patients respond rapidly to antibiotics-remains a clinically significant dilemma. We report the case of a 50-year-old male presenting with acute right periorbital swelling, proptosis, ocular pain, and headache. Magnetic resonance imaging (MRI) confirmed right cavernous sinus thrombosis secondary to bilateral sinusitis. After multidisciplinary review, anticoagulation was withheld due to the patient's prompt clinical improvement on targeted intravenous antibiotics (meropenem/ertapenem) and concerns regarding bleeding risk. Complete symptomatic and radiological recovery was achieved, as evidenced by serial MRI follow-up over eight months. This case demonstrates that in selected patients with septic CST and a treatable infectious source, aggressive antibiotic therapy alone may lead to full resolution. It highlights the value of individualized management and contributes to the ongoing discussion on the timing and necessity of anticoagulation in this complex condition.