The cavernous sinus contains cranial nerves III, IV, V-1, V-2, and VI. The internal carotid artery also runs through this space.
Cavernous sinus thrombosis occurs when a clot forms in the cavernous sinus, which is a space in the skull in which blood drains from the brain towards the heart. Common symptoms of cavernous sinus thrombosis include proptosis, headache, and decreased ocular range of motion due to impingement of cranial nerves III, IV, and VI. Risk factors for developing a cavernous sinus thrombosis include hypercoagulability, as well as sinus, dental, ear, and nasal infections. S. auerus, and S. pneumococcus are the most common causal organisms, although sometimes no organism is identified. The mainstay of treatment is antibiotics, with or without surgical drainage.
Fiore et. al, discuss the differential diagnosis of pain in the non-red eye. They mention several intracranial processes, including cavernous sinus thrombosis, as well as acute angle-closure glaucoma and giant cell arteritis. They note that cavernous sinus thrombosis typically presents with "rapid onset of unilateral periorbital swelling, photophobia, chemosis [swollen conjunctiva], proptosis, headache, or cranial nerve palsies." The infection often spreads to the contralateral eye within 48 hours.
Desa and Green discuss current recommendations for treatment of cavernous sinus thromboses. They recommend urgent, surgical drainage, as well as a broad-spectrum antibiotic regimen that includes a cephalosporin, nafcillin, and metronidazole, until cultures and sensitivities are returned. The use of steroids was found to be harmful, and the use of anticoagulation is still under debate.
Figure A shows a presentation of severe cavernous sinus thrombosis, with noted proptosis. Figure B shows an MRI of a 65-year-old woman presenting with double vision and retro-orbital pain, found to have a cavernous sinus thrombosis. Illustration A shows the anatomy of the cavernous sinus, including cranial nerves and blood vessels running through it.
Answer 2-5: Cranial nerves V-3, VII, VIII, IX, XI, and XII do not run through the cavernous sinus.
Fiore DC, Pasternak AV, Radwan RM. Pain in the quiet (not red) eye. Am Fam Physician. 2010 Jul 1;82(1):69-73. 20590074
PMID:20590074 (Link to Abstract)
Desa V, Green R. Cavernous sinus thrombosis: current therapy. J Oral Maxillofac Surg. 2012 Sep;70(9):2085-91.
PMID:22326173 (Link to Abstract)