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Abstract
Purpose
To report a case of orbital apex syndrome induced by penetrating orbital injury by a wire with the recovery proc-ess and clinical outcomes.
Case summary
A 40-year-old female visited our clinic after a penetrating orbital injury through the left inferomedial con-junctiva by a wire. The best corrected visual acuity of the left eye was 0.6, and ptosis and total ophthalmoplegia were observed. The patient showed a dilated pupil, swelling of the optic disc on fundus exam, and an inferior field defect on the automated perimetry. The computed tomography image revealed mild retrobulbar hemorrhage, but there was no orbital bony fracture. Enhancement of the optic nerve sheath was observed on the magnetic resonance image. The patient was admitted and received systemic antibiotics and steroid treatment. After 1 month, visual acuity, ptosis, and limitation in ad-duction were partly improved. After 3 months, depression and adduction were improved and the pupil size was normalized. However, further improvement was not observed after the one-year follow-up.
References
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Figure 1.
Fields of gazes on initial presentation show limitation of the extraocular muscle movement in all directions. Complete pto-sis of the left upper eyelid is also noted.
Figure 2.
(A) Optic disc photograph, OCT, and visual field test findings on initial presentation. Optic disc photograph (upper left) demonstrates whitish elevation at the superior disc margin. OCT (upper middle) findings show increase thickness of the superior RNFL which correlated with the optic disc photographs. Automated perimetry (upper right) reveals inferior altitudinal visual field defects on the gray-scale. (B) One month after injury, optic disc photograph shows no significant change. However, OCT shows the thickness of superior RNFL reduced to the normal range, and the visual field defects also improved accordingly. OCT = optical co-herent tomography; RNFL = retinal nerve fiber layer.
Figure 3.
Axial (left) and coronal (right) CT scan on initial presentation. CT demonstrates an increased reticular pattern with-in the right intraconal fat and around the postlaminar optic nerve suggesting mild retrobulbar hemorrhage (arrow). There is no orbital bony fracture.
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