Orbital Apex Syndrome Related to Isolated Sphenoid Fungal Sinusitis

Abstract

Orbital apex syndrome (OAS) has been described as malfunction of cranial nerve II in the optic canal and cranial nerves III, IV, V1, and VI in the superior orbital fissure due to vascular compromise, compression, or infiltration. Symptoms include ophthalmoplegia, ptosis, decreased corneal sensation, and vision loss. There are many potential causes of OAS including inflammation, infection, iatrogenic, neoplasm, vascular disease, or trauma. Among these, however, fungal sinusitis is one of the more rarely reported etiologies. Infections of the sphenoid sinuses typically occur in conjunction with other paranasal sinuses, while isolated sphenoid sinusitis is uncommon. In this case report, we describe OAS due to isolated sphenoid fungal sinusitis in a 67-year old man who presented with periorbital pain, acute vision loss, and ophthalmoplegia. He was treated surgically and was given postoperative antifungal agents as well as steroids for three months. We present this rare case along with a literature review of OAS.