Multiple cranial nerve problems from a lesion in the cavernous sinus, causing eye movement problems, pain, and sensory changes.
Cavernous sinus syndrome occurs when there's a problem affecting the cavernous sinus, a venous structure at the base of the skull. Multiple cranial nerves pass through here, so lesions cause combinations of eye movement problems, pain, and facial numbness.
Key Takeaways
- Multiple cranial nerves affected simultaneously
- Eye movement problems, pain, numbness
- Many possible causes—infection, tumor, vascular, inflammation
- Urgent evaluation needed—some causes are emergencies
- Treatment depends on underlying cause
Anatomy
The cavernous sinus contains:
- Cranial nerves III, IV, VI (eye movement)
- Cranial nerve V1, V2 (facial sensation)
- Sympathetic fibers
- Internal carotid artery
Symptoms
Eye Symptoms
- Double vision from multiple nerve involvement
- Ptosis (third nerve)
- Limited eye movement in multiple directions
- Proptosis (bulging eye)
- Pupil abnormalities
Pain and Sensory
Causes
Vascular
- Carotid-cavernous fistula
- Aneurysm
- Cavernous sinus thrombosis
Infectious
- Bacterial (often from sinus infection)
- Fungal (aspergillosis, mucormycosis)
Inflammatory
- Tolosa-Hunt syndrome
- Sarcoidosis
Neoplastic
- Meningioma
- Pituitary adenoma extension
- Metastases
- Lymphoma
Diagnosis
- MRI and MRA brain
- CT angiography
- Blood tests (infection, inflammation markers)
- Sometimes biopsy needed
- Lumbar puncture if infection suspected
Treatment
- Depends entirely on cause
- Antibiotics/antifungals for infection
- Anticoagulation for thrombosis
- Surgery or radiation for tumors
- Steroids for inflammation
Medical Disclaimer: This information is for educational purposes only and does not replace professional medical advice.
Medically Reviewed Content
This article meets our editorial standards
- Written by:
- Hashemi Eye Care Medical Team
- Medically reviewed by:
- Board-Certified Neuro-Ophthalmologist (MD, Neuro-Ophthalmology)
- Last reviewed:
- January 30, 2025