J Korean Ophthalmol Soc.  2016 Dec;57(12):1994-1997. 10.3341/jkos.2016.57.12.1994.

Orbital Apex Syndrome after Uneventful Phacoemulsification

• Yoo JH
• Nam KY
• Lee SU
• Lee SJ

• KMID: 2362722
• DOI: http://doi.org/10.3341/jkos.2016.57.12.1994

Abstract

PURPOSE
We report a case of orbital apex syndrome associated with ocular ischemic syndrome after unenventful cataract surgery.
CASE SUMMARY
A 74-year-old female came to our clinic with vision loss, ptosis, total ophthalmoplegia and ocular pain in the left eye after cataract surgery. On radiologic examination, diffuse hypertrophy of the extraocular muscles and a crowded orbital apex were observed. Additionally, the arm to retina and choroidal filling times were delayed on fluorescence angiography. Based on these findings, the patient was diagnosed with ocular ischemia complicated by orbital apex syndrome. After prompt pulse steroid therapy, improvement in extraocular muscle and pupil movement, ptosis and proptosis were observed; however, visual acuity failed to return to baseline.
CONCLUSIONS
We report a rare case of orbital apex syndrome associated with ocular ischemic syndrome after cataract surgery, indicating the orbital apex syndrome may occur in healthy patients after uneventful cataract surgery.

Keyword

Ocular ischemic syndrome; Orbital apex syndrome; Idiopathic orbital inflammatory disease

MeSH Terms

Aged
Arm
Cataract
Choroid
Exophthalmos
Female
Fluorescein Angiography
Humans
Hypertrophy
Ischemia
Muscles
Ophthalmoplegia
Orbit*
Phacoemulsification*
Pupil
Retina
Visual Acuity

Figure

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  Figure 1. Clinical, fundus photographs and imaging studies of the patient. (A) Edema and ptosis of the left eye. (B) Numerous blot and dot hemorrhages in the midperipheral retina and posterior pole, an irregularly dilated retinal vein, and papilledema of the left eye on fundus photography. (C-E) Delayed and patchy choroidal filling, prolonged arteriovenous transit time, an irregularly dilated retinal vein, peripheral capillary non-perfusion, and dye leakage from peripheral capillaries during fluorescein angiography. (F) Computed tomography imaging; diffuse increases in soft tissue density at the orbital apex. (G) Magnetic resonance imaging; diffuse hypointensity around the orbital apex. (H) Optic disc pallor 7 weeks after the first presentation.

Reference

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