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Orbital Inflammatory Syndromes
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Jaspreet Sukhija, Savleen Kaur
Orbital inflammatory signs in these patients include acute orbital myositis, perioptic neuritis, or dacryoadenitis, without zoster rash.24 A number of cases presenting as orbital apex syndrome have been reported. Herpes zoster ophthalmicus preceded the ophthalmoplegia as orbital apex syndrome by a mean interval of 9.5 days in one such series. Sixty-five percent of these cases recovered completely or partially after antiviral and steroid therapy, although anisocoria remained in most cases.25 Authors suggest combined antiviral and steroid therapy should be effective in cases of orbital apex syndrome if the steroid therapy is used for at least 4 months.26 Ophthalmoplegia and optic neuritis are rare but are responsive to antiviral or steroid treatment. Suspicion of orbital invasion should be kept within 14 days after onset of herpes zoster ophthalmicus.
Invasive aspergillosis
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Unlike acute invasive Aspergillus sinusitis, the chronic form of the disease tends to occur in patients carrying a lesser degree of immunosuppression, such as patients with poorly controlled diabetes mellitus and patients on chronic steroids therapy [83]. Patients usually present with the orbital apex syndrome are characterized by decreasing vision and ocular immobility resulting from orbital mass. Chronic invasive sinus aspergillosis carries a poor prognosis and should be managed similar to acute invasive disease.
Acute severe rhinological infection
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
Patients with chronic invasive fungal sinusitis are often immunosuppressed from diabetes mellitus or prolonged treatment with steroids. Although it has an indolent course, it can be quite extensive at the time of presentation, occasionally with involvement of the cavernous sinus and cerebral infarcts. Typical symptoms include unilateral nasal obstruction and discoloured nasal discharge. Not uncommonly, it can manifest as orbital apex syndrome when the fungal mass has eroded into the orbital apex (Figure 2.4). Optic neuropathy presenting as diminished visual acuity, as well as ophthalmoplegia from multiple cranial nerves palsies, are the hallmarks of orbital apex syndrome.
Acquired Ophthalmoplegia in Older Children and Adults
Published in Journal of Binocular Vision and Ocular Motility, 2018
The anatomy of the orbital apex is significant for the complex association between bony, neural, and vascular elements.10 Orbital apex syndrome is a term used to describe ophthalmoplegia involving all the cranial nerves entering the orbit through the superior orbital fissure with associated optic neuropathy as it also affects the optic canal.6,7 Tolosa–Hunt syndrome presents as a painful ophthalmoplegia involving the trigeminal nerve, but excluding the optic nerve, and for which no pathology can be determined. It may be caused by idiopathic granulomatous inflammation between the orbit and superior orbital fissure. It is a diagnosis of exclusion.6,7
Herpes Zoster Ophthalmicus with Orbital Apex Syndrome—Difference in Outcomes and Literature Review
Published in Ocular Immunology and Inflammation, 2018
Jie Jie Lim, Yu Ming Ong, M. Zain Wan Zalina, May May Choo
In the cases of our two patients, the first patient presented to us with a severe form of orbital apex syndrome only at the third week after the onset of rashes. Oral acyclovir and systemic steroid treatment were started at the third week of onset. The effectiveness of acyclovir therapy in our patient has been reduced due to the delay in initiation of treatment,6 while the second case represents a milder case that was probably attributed to early administration of oral acyclovir by the general practitioner. However, the optimal time for initiation of treatment is within 72 hours from the onset of the rash.5,15
A Proposed Diagnostic Algorithm for Fungal Orbital Infections after 20 Years of Experience in a Tertiary Eye Care Center– Egypt
Published in Ocular Immunology and Inflammation, 2023
Mohamed Ashraf Eldesouky, Hazem A. Elbedewy
The acute orbital apex syndrome was the most common presentation in this study. The onset of orbital mucormycosis was associated with nonspecific symptoms such as nasal congestion, postnasal drip, dark blood-tinged or purulent rhinorrhea, sinus tenderness, headache, fever, and malaise for few days. Once the organism had reached the orbit, progression of the infection was very rapid and the full picture of acute orbital apex syndrome was completed in 3 to 4 days. Previous studies reported the rapidly progressive painless orbital apex7,8 and high incidence brain complications with fungal orbital infections.9