Traumatic Orbital Apex Syndrome: A Rare Entity

Abstract

BACKGROUND:

Orbital Apex Syndrome (OAS) is an extremely rare significant ocular complication affecting the multiple cranial nerves following craniomaxillofacial trauma. The syndrome's clinical features predominantly involve a combination of ophthalmoplegia, proptosis, ptosis, hypoesthesia of the forehead, and vision loss.

Case Presentation:

We present the case of a young adult male who experienced traumatic OAS with facial bone fractures following a high energy injury from an RTA. The patient exhibited ptosis, complete ophthalmoplegia in the left eye and visual acuity impairment. Diagnostic imaging revealed the left supraorbital rim, which was comminuted and depressed. Additionally, there were fractures of the orbital roof, medial orbital wall, floor and also right ZMC fracture. Traumatic OAS was caused by direct compression due to a displaced fracture segment from the superior orbit. The patient was treated with a combination of emergent pharmacological and early surgical intervention and close monitoring thereafter. While there was some improvement in extraocular muscle movements, the visual impairment persisted.

Conclusion:

The overall recovery of vision after OAS is generally poor, although steroid therapy or surgical decompression did appear to improve the remaining visual parameters especially if the patient presents to the E.R immediately after the injury. Additional standardized patient data is required to clarify the effectiveness of these therapies.