What is Orbital apex syndrome?

Orbital apex syndrome

It is an abnormal function of cranial nerve (CN) 2,3,4,5 and 6 in varying combination. It is also known as Jacod syndrome where there is a collection of cranial nerve deficits associated with a mass lesion near the apex of the orbit of the eye.

Causes of orbital apex syndrome

  • Posterior ethmoidal or sphenoidal sinusitis: These sinuses are adjacent to the apex of the orbit
  • In a diabetic patient, Rhinocerebral mucormycosis is the most frequent cause of orbital apex syndrome
  • Orbital apex syndrome may be caused by a tumour of the middle cranial fossa (near the apex of the orbit) and by herpes zoster
  • Aspergillus may cause an orbital apex syndrome in immunocompromised hosts and may have a subacute presentation

Clinical features of orbital apex syndrome

  • Complete Ophthalmoplegia and ptosis (CN 3, 4 and 6)
  • Decreased corneal sensation and hypoesthesia of the upper face (CN 5) and
  • Vision loss and relative afferent pupillary defect (CN 2)


  • High-resolution CT scan with a slice thickness of 3mm or less
  • MRI


  • If vision is impaired, then surgical intervention is required.

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