Orbital apex syndrome from bacterial sinusitis without orbital cellulitis

Margaret L Pfeiffer; Helen A Merritt; Lucy A Bailey; Karina Richani; Margaret E Phillips

doi:10.1016/j.ajoc.2018.01.041

Orbital apex syndrome from bacterial sinusitis without orbital cellulitis

Am J Ophthalmol Case Rep. 2018 Jan 31:10:84-86. doi: 10.1016/j.ajoc.2018.01.041. eCollection 2018 Jun.

Authors

Margaret L Pfeiffer^{1

2}, Helen A Merritt^{1

2}, Lucy A Bailey^{1

2}, Karina Richani^{1

2}, Margaret E Phillips^{1

2}

Affiliations

¹ Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin St., MSB 7.024, Houston, TX, 77030, United States.
² Robert Cizik Eye Clinic, 6400 Fannin St., Suite 1800, Houston, TX, 77030, United States.

Abstract

Purpose: To describe a case of orbital apex syndrome as a result of isolated bacterial sinusitis.

Observations: A 63-year-old woman presented with an orbital apex syndrome from isolated bacterial sinusitis with rapidly declining visual acuity to no light perception. We compared our case with 6 similar cases of severe vision loss from isolated bacterial sinusitis. In contrast to previously published cases, our patient presented with good vision yet deteriorated to no light perception despite appropriate treatment.

Conclusions and importance: Orbital apex syndrome can present as a constellation of cranial neuropathies including optic neuropathy from conditions affecting the orbital apex. Although vision loss remained permanent, prompt initiation of broad-spectrum antibiotics and antifungals and surgical intervention prevented further extension of infection into intracranial structures.

Keywords: Optic neuropathy; Orbital apex syndrome.