J Korean Ophthalmol Soc.  2018 Sep;59(9):893-898. 10.3341/jkos.2018.59.9.893.

Two Cases of Orbital Apex Syndrome after Blunt Orbital Trauma

• Yang SC
• Choi HY
• Jeon H

• KMID: 2420341
• DOI: http://doi.org/10.3341/jkos.2018.59.9.893

Abstract

PURPOSE
To report two cases of orbital apex syndrome caused by blunt orbital trauma without structural damage of the orbit.
CASE SUMMARY
(Case 1) A 50-year-old male came to our clinic complaining of visual loss after blunt orbital trauma by a metal bar. The best-corrected visual acuity was no light perception and light reflex was not observed in the affected eye. He also presented with complete ptosis and ophthalmoplegia with relative sparing of adduction and depression. High signal intensity of the orbital soft tissue including the optic nerve sheath was revealed using a T2-weighted image in magnetic resonance imaging. After starting steroid pulse therapy, his visual acuity improved to counting fingers on the third day. Ocular movement and levator function recovered to the normal range while visual acuity remained counting fingers. (Case 2) A 64-year-old female presented with complete ptosis after trauma to her right eyeball. The best-corrected visual acuity was 20/25 in the right eye. Complete ptosis and ophthalmoplegia with relative sparing of abduction and depression in the right eye were observed at the initial presentation. Magnetic resonance images showed enhancement of the right periphery optic nerve and distal rectus muscle. Two months after undergoing steroid pulse therapy, levator function and ocular movement recovered completely, and visual acuity improved to 20/20.
CONCLUSIONS
The orbital apex syndrome caused by blunt orbital trauma showed good response to steroid pulse therapy. Steroid treatments may therefore be considered for the treatment of traumatic orbital apex syndrome.

Keyword

Blunt orbital trauma; Orbital apex syndrome

MeSH Terms

Depression
Female
Fingers
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Ophthalmoplegia
Optic Nerve
Orbit*
Reference Values
Reflex
Visual Acuity

Figure

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  Figure 1. Nine diagnostic position of gaze field in case 1. Complete ptosis and ophthalmoplegia with partial sparing of adduction and depression in left eye was observed at initial presentation (A). At 5 months after treatment, ptosis and ophthalmoplegia were completely recovered (B).

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  Figure 2. Pattern visual evoked potential (VEP) of Case 1. Pattern VEP showed low amplitude in the affected left eye.

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  Figure 3. Computed tomography (CT) and magnetic resonance image (MRI) of the case 1 patient. Axial (A) CT scan showed no sign of orbital wall fracture and retrobulbar hemorrhage. Axial (B) T2-weighted image of magnetic resonance scan presented high signal intensity of the intraconal space including left optic nerve and soft tissue.

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  Figure 4. Nine diagnostic position of gaze field in case 2. Complete ptosis and ophthalmoplegia with partial sparing of abduction and depression in right eye was observed at initial presentation (A). Ptosis and ophthalmoplegia recovered completely at 2 months after treatment (B).

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  Figure 5. Pattern visual evoked potential (VEP) of Case 2. Pattern VEP showed reduction in the amplitude in the right eye.

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  Figure 6. Axial (A) and coronal (B) magnetic resonance imaging (MRI) (T2-weighted image) scan at tenth day after injury. MRI showed enhancement of the right optic nerve sheath, distal rectus muscle and surrounding soft tissue.

Reference

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