Orbital apex syndrome.
OBJECTIVE
Visual loss from optic neuropathy and ophthalmoplegia involving multiple cranial nerves are the hallmarks of an orbital apex syndrome. Historically, the terms superior orbital fissure, orbital apex, and cavernous sinus have been used to define the anatomic locations of a disease process. However, the diagnostic evaluation and management is similar for each of these entities. The authors reviewed the literature on the diagnosis and evaluation of disorders involving the orbital apex.


RESULTS
High-resolution MRI is the preferred modality for evaluating most lesions involving the orbital apex. CT is a useful tool in the setting of trauma, to evaluate bone involvement, or when MRI is contraindicated. Although laboratory studies may be useful adjuncts in the diagnostic evaluation of lesions involving the orbital apex, surgical biopsy is often required for definitive diagnosis.


CONCLUSIONS
Orbital apex syndromes may result from a variety of inflammatory, infectious, neoplastic, iatrogenic/traumatic, and vascular conditions. A detailed history with review of systems is important in narrowing the differential diagnosis. Management is directed at the underlying cause and may be guided by surgical biopsy. Corticosteroids may be useful if an inflammatory etiology is suspected, but should be used with caution.
Yeh
Steven
S
Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas 77030, USA.
Foroozan
Rod
R
D003391:Cranial Nerves; D006801:Humans; D009886:Ophthalmoplegia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D009901:Optic Nerve Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D009916:Orbital Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D010523:Peripheral Nervous System Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013577:Syndrome; D014786:Vision Disorders / Q000209:etiology*