Open AccessOrbital Apex Syndrome: An Uncommon Complication caused by a Common Nasal Commensal
Author(s) -
C. Chandrakiran,
Trupthi Uthappa
Publication year - 2022
Publication title -
bengal journal of otolaryngology and head neck surgery
Language(s) - English
Resource type - Journals
eISSN - 2395-2407
pISSN - 2395-2393
DOI - 10.47210/bjohns.2021.v29i3.556
Subject(s) - medicine , hypoesthesia , sinusitis , orbital cellulitis , apex (geometry) , forehead , ptosis , surgery , staphylococcus epidermidis , complication , orbit (dynamics) , anatomy , cellulitis , staphylococcus aureus , genetics , aerospace engineering , biology , bacteria , engineering
Orbital apex syndrome, an uncommon condition seen in ENT practice, is characterised by multiple cranial neuropathies, presenting as visual loss, ophthalmoplegia, ptosis and hypoesthesia of forehead due to involvement of Cranial nerves III, IV, VI and V1.Case ReportThis is a case of an 80-year-old female patient, with poorly controlled Type 2 Diabetes mellitus and Hypertension, who presented with right sided headache of 10 days duration, drooping of right eyelid and decreased vision in right eye for 3 days. Clinically, there were features suggestive of right orbital apex syndrome. MRI Brain showed abnormal enhancement in right orbital apex with subtle enhancement of optic nerve in optic canal and intense enhancement of mucosal thickening in sphenoid sinus. Aerobic culture report of the purulent nasal discharge revealed Staphylococcus epidermidis.DiscussionAetiology of this condition is varied. Rarely known to occur following bacterial sinusitis, it is most commonly seen secondary to fungal sinusitis or orbital cellulitis involving orbital apex. Here we report an unusual case occurring secondary to Staphylococcus epidermidis sinusitis. In conclusion, although acute orbital apex syndrome is usually associated with invasive fungal sinusitis, clinicians must be aware that bacterial sinusitis may also present with a similar aggressive pattern.