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Background: Sinus vein thrombosis is a rare intracerebral complication of mastoiditis. We report on the clinical ophthalmologic symptomatology of this secondary illness., History: two young female patients, aged 14 and 3.5 years, presented at our pediatric ophthalmology section due to diplopia. Both girls had suffered 1-2 weeks earlier from otitis media, which had been treated with antibiotics. Other neurological symptoms were not reported., Clinical Course: Best corrected visual acuity was 20/20 OD/OS in both patients. Ocular alignment revealed a bilateral abduction deficit in the 14-year-old girl and a monolateral abduction deficit of the right eye in the younger patient. Ophthalmoscopic examination evidenced bilateral papilledema in both patients. Magnetic resonance tomography and magnetic resonance angiography showed mastoiditis and thrombosis of the sigmoid and transverse sinuses., Therapy: Following mastoidectomy, high-dose antibiotic therapy, and full-dose heparin therapy, rapid improvement occurred., Conclusions: Thrombosis of the sigmoid sinus following mastoiditis is a rare but severe complication of middle ear inflammation. Immediate surgical and antibiotic therapy is necessary. Symptoms can possibly occur even when the primary focus seems to resolve.