Case Of Orbital Apex Syndrome Research Articles

Orbital Apex Syndrome Caused by Invasive Fungal Sinusitis due to Candida glabrata: A Case Report

Purpose: To report a case of orbital apex syndrome resulting from invasive fungal sinusitis attributed to the unusual <i>Candida glabrata</i> species.Case summary: A 76-year-old patient presented with persistent left-sided orbital pain, headaches, and blurred vision for 3 weeks. The patient had a history of uncontrolled diabetes, chronic kidney failure, and angina, and was treated for a COVID-19 infection 1 month prior to admission. Contrast-enhanced computed tomography scans revealed extensive bilateral sinusitis affecting the left optic nerve. The patient underwent endoscopic sinus surgery, which included nasal cavity biopsy, conducted by an otorhinolaryngologist. Histopathological analysis using Gömöri methenamine silver stains identified <i>Candida</i>. Cultures from sinus specimens later grew <i>Candida glabrata</i>. Treatment involved daily IV amphotericin B followed by oral itraconazole. After 6 months, the patient fully recovered from fungal sinusitis but continued to experience negative light perception in the left eye and progressed to complete ophthalmoplegia, consistent with orbital apex syndrome.Conclusions: Reports of invasive fungal sinusitis caused by <i>Candida</i> infections are rare globally. This report marks the first occurrence in this country. Effective management requires careful assessment and appropriate treatment tailored to the specific species, especially considering the risk of orbital extension of the inflammatory lesion.

Presentation and Management of a Complex Orbital Apex Syndrome From Penetrating Mechanical Spring Hook: A Case Report

Our case report demonstrates the management of a unique penetrating orbital injury. The intraorbital foreign body was an approximately 22 cm long metal dishwasher spring hook lodged into the left orbital apex. An ophthalmological check-up a couple of weeks following the removal surgery discerned the patient had anunprecedented case of orbital apex syndrome. We present this unique case so physicians, medical students, and other emergency and medical professionals can learn about the diagnostic, surgical, and multidisciplinary management necessary to achieve a favorable clinical outcome.

Orbital Apex Syndrome and Central Retinal Vein Occlusion after Blow-out Fracture Repair

Purpose: To report a case of orbital apex syndrome and central retinal vein occlusion after blow-out fracture repair.Case summary: A 22-year-old man who underwent emergency re-operation in a department of plastic surgery due to pain, decreased visual acuity, and ophthalmoplegia in all direction after orbital blow-out fracture repair was referred to ophthalmologist on postoperative day 2 and there was no improvement in symptoms. He showed severe complications, including optic neuropathy and ophthalmoplegia in all direction, central retinal vein occlusion, and outer retinal disruption caused by orbital apex hemorrhage. Although we were concerned that it was too late, we started high dose steroid intravenous pulse treatment and the visual acuity, ophthalmoplegia, and retinal findings were improved. However, the optic atrophy and visual field defect did not.Conclusions: After a complicated blow-out fracture repair in other department, if a patient shows severely decreased visual acuity or ocular movement limitation, a thorough and immediate ophthalmologic examination is recommended. During ophthalmologic examination, meticulous examination of the entire eye, including the retina, is required, in addition to general orbital complications. A relatively good prognosis can be expected through accurate cause analysis and appropriate treatment for the confirmed abnormal findings.

Frozen overnight: Acute orbital apex syndrome caused by aspergillosis.

to describe a rare case of orbital apex syndrome caused by aspergillosis with acute presentation. retrospective case report of a 70-year-old man who developed unilateral ophthalmoplegia overnight. He was initially given the diagnosis of suspect Tolosa-Hunt syndrome, but biopsy of the involved tissue showed aspergillosis. orbital apex syndrome caused by fungal disease is a life-threatening condition that should be promptly diagnosed and treated. It may present acutely and should not be misdiagnosed as Tolosa-Hunt syndrome. To our knowledge this is the first such case report in the English ophthalmic language Literature.

P.089 A report of a patient presenting with orbital apex syndrome secondary to NK cell lymphoma (nasal type)

Background: Orbital apex syndrome (OAS) can be caused by a broad range of disorders. There are several challenges present in the evaluation of these patients and in reaching a final diagnosis. We report the case of a 69-year-old male who presented with OAS that was determined to be secondary to a rare malignancy (NK cell lymphoma, nasal type). Methods: We analyze the pitfalls and diagnostic delays in this patient’s evaluation. Furthermore we propose a work up for undifferentiated cases of OAS. Results: To accurately diagnose the underlying cause of OAS, a direct biopsy should be obtained whenever possible. The appropriate imaging sequences should be arranged as lesions in this region can be easily missed. Adjunct tests include assessment in the serum and CSF for granulomatous and infectious diseases, along with chest imaging. As many causes are PET enhancing, PET CT is a useful modality for identifying sites for biopsy. Conclusions: OAS can provide a diagnostic challenge for clinicians, however a systematic approach can help determine the underlying etiology.

Covid associated orbital apex syndrome: Madras ENT Research Foundation experience

<p class="abstract">The second wave of corona virus pandemic is currently raging through India since last few weeks. Since last year, COVID-19 has brought in a multitude of challenging manifestations in the ENT regions. One such rare and complex entity is OAS (orbital apex syndrome). This case series highlighted our experience in 2020 with managing two such cases of OAS associated with COVID-19 infection. Their clinical and radiological presentation was discussed and their management protocol was explained with references from relevant literature. Although elderly patients with co-morbidities were considered to have highest risk for COVID-19 associated neurologic and ophthalmic complications earlier, now it was found to affect younger healthy individuals as noted in our cases. Knowledge about such virulent complications of COVID-19 is essential for otolaryngologists, to manage this life-threatening entity in a timely manner.</p>

Facial nerve palsy as an unusual presentation of orbital apex syndrome

Clinical cases of orbital apex syndrome are rare and most commonly manifested as a complication of fungal sinusitis, mainly in immunocompromised and poorly controlled diabetic patients. Rhino-orbital mucormycosis is a rare opportunistic, aggressive and fatal infection caused by mucor. The complex presentation of orbital apex syndrome not only poses a diagnostic challenge but also demands a multidisciplinary approach in patient management. Facial nerve palsy is an unusual presentation in orbital apex syndrome. We report the case of a 64-year-old diabetic patient presenting with ophthalmoplegia and visual loss associated with facial nerve palsy. Prompt ophthalmologic and otolaryngologic intervention with imaging and histologic confirmation, followed by early initiation of antifungal and antimicrobial therapy, were integral to preventing further complications, and reducing morbidity and mortality.

Orbital Apex Syndrome: A Review.

Orbital apex syndrome is characterized by vision loss from optic neuropathy and ophthalmoplegia due to the involvement of ocular motor nerves in the anatomical region of the orbital apex. Patients could present with signs and symptoms deriving from the involvement of structures within the orbital apex, the superior orbital fissure or the cavernous sinus. The primary focus of the ophthalmologist should be to locate the lesion and then identify its etiology. Clinical evaluation holds key to diagnosis which is aided then by certain serological and lab investigations and neuro-imaging modalities including brain and orbital MRI (Magnetic Resonance Imaging) with contrast, CT (Computed Tomography) scans. In rare instances, a biopsy may be needed to aid in diagnosis. Treatment depends on what the nature of the lesion is with inflammatory conditions usually responding to steroids and infections to anti-microbial agents. Through this review, the authors attempt to decode the approach to localizing the lesion, the etiopathology and the management of cases of orbital apex syndrome

Ninteen cases of orbital apex syndrome at tohoku university: A case series

Ninteen cases of orbital apex syndrome at tohoku university: A case series

Orbital apex syndrome: An unusual complication of invasive mucormycosis

Orbital apex syndrome is a rare manifestation of invasive mucormycosis. We report a case of orbital apex syndrome in a diabetic patient which not only posed a diagnostic challenge but also required a multidisciplinary approach in treatment and management. Prompt imaging followed by early initiation of antimicrobial therapy along with timely surgical intervention were integral in preventing further complications and reducing mortality. However, despite these measures, the patient sustained partial vision loss due to endophthalmitis as a complication.

Orbital apex syndrome from bacterial sinusitis without orbital cellulitis

PurposeTo describe a case of orbital apex syndrome as a result of isolated bacterial sinusitis. ObservationsA 63-year-old woman presented with an orbital apex syndrome from isolated bacterial sinusitis with rapidly declining visual acuity to no light perception. We compared our case with 6 similar cases of severe vision loss from isolated bacterial sinusitis. In contrast to previously published cases, our patient presented with good vision yet deteriorated to no light perception despite appropriate treatment. Conclusions and importanceOrbital apex syndrome can present as a constellation of cranial neuropathies including optic neuropathy from conditions affecting the orbital apex. Although vision loss remained permanent, prompt initiation of broad-spectrum antibiotics and antifungals and surgical intervention prevented further extension of infection into intracranial structures.

A Case of Orbital Apex Syndrome with Central Retinal Artery and Vein Occlusion Following Trauma

A Case of Orbital Apex Syndrome with Central Retinal Artery and Vein Occlusion Following Trauma

Two Cases of Orbital Apex Syndrome after Blunt Orbital Trauma

Two Cases of Orbital Apex Syndrome after Blunt Orbital Trauma

Orbital apex syndrome secondary to a fungal nasal septal abscess caused by Scedosporium apiospermum in a patient with uncontrolled diabetes: a case report

BackgroundOrbital apex syndrome is a localized type of orbital cellulitis, where mass lesions occur at the apex of the cranial nerves. Although nasal septal abscess is uncommon, the organism most likely to cause nasal septal abscess is Staphylococcus aureus, and fungal septal abscesses are rare. Here we present an extremely rare and serious case of orbital apex syndrome secondary to fungal nasal septal abscess caused by Scedosporium apiospermum in a patient with uncontrolled diabetes.Case presentationA 59-year-old man with a 1-month history of headache underwent consultation in an otolaryngological clinic of a general hospital. He was diagnosed with nasal septal abscess and was treated with incisional drainage and 1 month of an antibiotic drip; however, his symptoms persisted. The patient later complained of diplopia due to bilateral abducens nerve palsy, and was then referred to the department of Otolaryngology – Head and Neck Surgery, Kobe City Medical Center General Hospital. The septal lesion was biopsied under general anesthesia, and S. apiospermum was detected using polymerase chain reaction. The patient was treated with an antifungal drug and surgical resection of the lesion was performed. Although the patient survived, he lost his eyesight.ConclusionsThis patient represents the second reported case of nasal septal abscess and orbital apex syndrome caused by S. apiospermum. If not treated properly, septal abscess can be life-threatening and cause severe complications, such as ablepsia.

A Case of Orbital Apex Syndrome Caused by Squamous Cell Carcinoma from the Sphenoidal Sinus

A Case of Orbital Apex Syndrome Caused by Squamous Cell Carcinoma from the Sphenoidal Sinus

침습성 진균성 부비동염에 의한 안와첨부증후군 1예

Invasive fungal sinusitis is a slowly destructive process that most commonly affects the maxillary and sphenoid sinus, but may involve any paranasal sinus. Orbital apex syndrome (OAS) has been described as a syndrome involving damage to the oculomotor nerve, trochlear nerve, abducens nerve and ophthalmic branch of the trigeminal nerve in association with optic nerve dysfunction. The symptoms of OAS are characterized by blindness, ptosis, fixed dilated pupils and ophthalmoplegia. In this case, we experienced one case of orbital apex syndrome due to invasive fungal sinusitis. A 67-year-old woman with pulsatile headache was admitted to the Department of Neurosurgery. Suspicious sphenoid sinus and surrounding lesion on imaging study was removed by endoscopic sinus surgery. Adjuvant antifungal therapy was attemped. The patient recovered from fungal sinusitis but visual acuity was partially recovered. (J Clinical Otolaryngol 2014;25:219-223)

Perineural Spread of Head And Neck Cancer Resulting in Orbital Apex Syndrome: Report of Four Cases

Perineural invasion is an uncommon type of tumor dissemination that occurs when malignant cells gain access to the perineural space and spread along the nerves to distant locations. This, in turn, may result in orbital apex syndrome (OAS). Although rare, OAS typically damages the oculomotor nerve (III), trochlear nerve (IV), abducens nerve (VI), and trigeminal nerve (V) in association with optic nerve dysfunction. The authors report four cases of OAS diagnosed in patients undergoing treatment for squamous cell carcinoma of the nasopharynx (2), larynx (1) and tongue (1).

A Case of Orbital Apex Syndrome Induced by Penetrating Orbital Injury with Long-Term Results

A Case of Orbital Apex Syndrome Induced by Penetrating Orbital Injury with Long-Term Results

Aspergillus osteomyelitis of the lumbar spine complicated with orbital apex syndrome: A potential role of the Batson's plexus in disease propagation

We report a rare case of orbital apex syndrome following epidural steroid injections of the lumbar spine in an immunocompetent individual with osteomyelitis and discitis caused by Aspergillus fumigatus. We suspect that the craniospinal venous system, also known as the Batson's plexus, was the main route for steroid-facilitated disease propagation from the spine to intracranial structures.

Study on the treatment of traumatic orbital apex syndrome by nasal endoscopic surgery

Orbital apex syndrome (OAS) is a complex disease caused by a variety of pathological factors, and trauma is one of the main factors/causes. Clinical data of 17 cases of traumatic OAS treated by nasal endoscopic surgery in our department from January 2002 to April 2009 were gathered and reviewed. Among them, the six patients presented with OAS after injury to the lateral wall of orbital apex. Seven other patients exhibited OAS after injury to the medial wall of orbital apex, two displayed OAS after zygomatic trauma, while OAS manifested in the other two patients with craniocerebral trauma 3 days after they had decompressive craniotomy--of them, one was blind in both eyes. In the 17 cases, 6 patients were without light sensation, 1 was blind in both eyes; the sight-chart index of eight patients was 0.1, that of three other patients was 0.1-0.2. Fifteen patients displayed eyeball movement disturbance (disorder) and cornea sensory disturbance (disorder), two were with the eyeball abducent disturbance. After the nasal endoscopic surgeries for OAS performed on the 17, the sight of the most patients was restored in varying degrees. The sight of nine patients was between 0.2 and 0.3, that of two patients was between 0.1 and 0.2, that of the other two patients was 0.1, and that of four patients remained unchanged. The eyeball movement and the cornea esthesia in 15 patients recovered from the surgeries, one patient recovered with good eyeball adducent movement and the cornea esthesia but with eyeball abducent disturbance, the other patient did not make a recovery from the eyeball immobility, cornea anesthesia and ptosis. A follow-up lasting 2 months to 2 years suggested that the 16 patients had stable recovery from the surgeries. Satisfactory results could be achieved in the treatment of traumatic OAS by nasal endoscopic surgery. From objective assessment of the therapeutic effects of traumatic OAS, it can be concluded that if a patient is diagnosed with fractures of the optic canal and the superior and medial walls of orbital apex, nasal endoscopic decompression of superior and medial walls of orbital apex and optic canal via the approach to the sphenoid and ethmoid sinuses is the most ideal operative therapy.