Tolosa-Hunt Syndrome: A Case Report

Abstract

Background: Idiopathic Orbital Inflammatory Syndrome (OIS) ranks as the third most prevalent orbital disease, following thyroid eye disease and orbital lymphoma. In cases of localized inflammation, various structures within the orbit can be affected. This includes the Extraocular Muscles (orbital myositis), lacrimal gland (dacryoadenitis), sclera (scleritis), uvea (uveitis), as well as the superior orbital fissure and cavernous sinus (Tolosa-Hunt syndrome). Case Presentation: In this report, we discuss the case of a 35-year-old man who went to the Emergency Department due to intense, throbbing pain in his eye orbit and half of his head on the right side. He had been experiencing this pain for two days. The pain was aggravated by eye movement and accompanied by ipsilateral redness, mild photophobia, and blurred vision. The patient had no significant medical history prior to this episode. Upon eye evaluation, findings included mild swelling of the right eyelids, painful eye movements, inferior corneal erosions, and conjunctival chemosis with superficial and deep vessel congestion. Visual acuity was reduced due to myopic refractive error. Magnetic Resonance Imaging (MRI) revealed a soft tissue lesion in the right orbital apex extending into the right cavernous sinus, suggesting an inflammatory etiology such as Tolosa-Hunt syndrome. To investigate further, the patient underwent various diagnostic tests, including laboratory investigations, chest X-rays, and serological tests. These tests revealed unremarkable findings, ruling out systemic pathology. The patient received intravenous Solumedrol (Methylprednisolone) followed by oral Prednisolone, resulting in a dramatic improvement in symptoms. Conclusion: This case highlights the importance of a comprehensive diagnostic approach in evaluating severe orbital and hemi cranial pain. Prompt initiation of corticosteroid therapy can lead to rapid symptom resolution and favorable outcomes in patients with Tolosa-Hunt syndrome.