A 60 year old gentleman presented with a left sphenocavernous syndrome resulting in impaired ocular motility, proptosis and visual loss in an otherwise clinically quiet eye. The history led to a clinical suspicion of posterior ethmoiditis, which was confirmed on C.T. scanning. Surgical drainage and antibiotic treatment resolved the symptoms, but visual impairment persisted. The differential diagnosis and management of sphenocavernous syndrome is discussed in context with this atypical presention of orbital cellulitis.
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