Cavernous Sinus Disease

Pathology in the cavernous sinus can cause injury to the following nerves:

  • Oculomotor (CN III)
  • Trochlear (CN IV)
  • Abducens (CN VI)

There may also be associated paraesthesia in the distribution of the ophthalmic branch of the trigeminal nerve.

Cavernous sinus disease classically presents with a painful ophthalmoplegia. There is associated chaemosis (conjunctival oedema), proptosis (click on the image to enlarge), severe headache and sometimes a Horner’s syndrome.


Causes include:

  • Tumours, for example lateral extension of a pituitary tumour, nasopharyngeal tumour and metastases
  • Carotid-cavernous aneurysm

It can also occur as a complication of:

  • Ethmoid, sphenoid or frontal sinus infection
  • Orbital cellulitis
  • Dental or midfacial infections
  • Frontal abscess (CT image demonstrating ring-enhancing lesion in the frontal lobe – click on the CT to enlarge)

Approximately 5% of ophthalmoplegias are secondary to cavernous sinus pathology.