Successful Conservative Management of a Case of Traumatic Superior Orbital Fissure Syndrome

Abstract

We report the case of a 22-year-old man who presented with complete ptosis, anisocoria, and total limitation of ocular motility of the right eye following blunt trauma. He was diagnosed to have traumatic superior orbital fissure syndrome based on clinical and radiologic evaluation. The patient achieved complete recovery of cranial nerve function. This unusual complication is reported in less than 1% of cases of craniomaxillofacial trauma. The clinical presentation with external and internal ophthalmoplegia but sparing of vision occurs as a result of the functional compromise of the neurovascular structures traversing the superior orbital fissure while sparing the optic nerve within the optic canal. Management may include observation, repair of associated fractures, megadose steroid therapy, and surgical decompression of the superior orbital fissure. A review of literature reveals that this condition with a unique ocular presentation is underreported in ophthalmic literature, perhaps as initial diagnosis may be obscured by coexisting craniofacial trauma.