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)
Diagnosis:
- High-resolution CT scan with a slice thickness
of 3mm or less
- MRI
Treatment:
- If vision is impaired, then surgical
intervention is required.
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