Orbital Apex Syndrome Resulting from Mixed Bacterial Sphenoid Sinusitis

Orbital apex syndrome (OAS) is an uncommon disorder characterized by visual loss, ophthalmoplegia, ptosis and hypoaesthesia of the forehead([1]). OAS may result from a variety of inflammatory, infectious, neoplastic and vascular conditions that cause damage to the superior orbital fissure (with resultant oculomotor (III), trochlear (IV), abducens (VI) and ophthalmic branch of the trigeminal nerve (V1) palsies) and to the optic canal leading to optic nerve (II) dysfunction. This case report describes the clinical development of OAS in a patient with bacterial sphenoid sinusitis. LEARNING POINTS: Orbital apex syndrome (OAS) is an uncommon manifestation of a wide range of disease entities, with management ranging from antibiotic therapy to immunosuppression and surgery. OAS can be life-threatening if there is disease invasion through ophthalmic vessels or bone fissures, leading to intra-cranial involvement. Without adequate knowledge and clinical suspicion, OAS can be easily missed or misdiagnosed, resulting in delayed treatment and devastating loss of function or even death.