This article reviews the contemporary literature for septic cavernous sinus thrombosis (CST) with a focus on anticoagulation. Modern emphasis is placed on suspecting and treating this condition early, which is aided by recognizing clinical features attributable to sepsis, orbital venous congestion, and involvement of cranial nerves within each cavernous sinus. Established treatments include high dose broad-spectrum parenteral antibiotics, and selective surgery for concurrent suppurations. The role of anticoagulation is contentious because its efficacy is undetermined and it may cause or exacerbate concurrent intracranial haemorrhage in patients with septic CST. Moreover, prospective trials of anticoagulation may never be performed due to the rarity of this condition. Nevertheless, retrospective reviews of published reports indicate that haemorrhage caused by anticoagulation is rare, and that early adjunctive anticoagulation is beneficial in these patients if commenced after excluding the haemorrhagic sequelae of CST radiologically.