A Case of Superior Orbital Fissure Syndrome Induced by Penetrating Orbital Injury

Kyeol Han; Min Ahn

doi:10.7469/JKOS.2015.56.04.592

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Han and Ahn: A Case of Superior Orbital Fissure Syndrome Induced by Penetrating Orbital Injury

Original Article

J Korean Ophthalmol Soc 2015;56(4):592-597.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.04.592

A Case of Superior Orbital Fissure Syndrome Induced by Penetrating Orbital Injury

Kyeol Han, MD¹, Min Ahn, MD, PhD^1,²

¹Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea

²Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea

￭ Address reprint requests to Min Ahn, MD, PhD Department of Ophthalmology, Chonbuk National University Hospital, #20 Geonji-ro, Deokjin-gu, Jeonju 561-712, Korea Tel: 82-63-250-1965, Fax: 82-63-250-1960 E-mail: ahnmin@jbnu.ac.kr

Received 11 July 201428 December 2014 Accepted 7 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose:

We report a case of superior orbital fissure syndrome induced by penetrating orbital injury caused by a steel wire and analyzed the clinical outcomes.

Case summary:

A 49-year-old female visited our clinic after a penetrating orbital injury through the right inferolateral conjunctiva caused by a steel wire. The best corrected visual acuity of the right eye was 0.8 and a fixed dilated pupil was detected. Partial ptosis and ophthalmoplegia were observed in the right eye. The computed tomography image revealed no sign of orbital wall fracture, retrobulbar hemorrhage or foreign body. Slightly increased signal intensity was observed on the magnetic resonance image but other abnormal findings of the extraocular muscle and optic nerve were not detected. Under the impression of superior orbital fissure syndrome, systemic steroid was administered orally. After 1 month, ptosis and ophthalmoplegia were partially improved. After 3 months, the pupil size and response were normalized.

Conclusions:

The oral steroid treatment was given to reduce the edema without orbital wall fracture after the penetrating orbital injury, which caused the superior orbital fissure syndrome. The symptom was relieved 3 months after the injury.

Keywords: Penetrating orbital injury, Superior orbital fissure syndrome

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Figure 1.

Ophthalmoplegia of the right eye and partial ptosis of the right upper eyelid are noted at 1 hour after the injury.

Figure 2.

Injury site on the inferolateral side of right bulbar conjunctiva (arrow).

Figure 3.

Axial (A) and coronal (B) CT scan at 1 hour after injury. There is no sign of orbital wall fracture, retrobulbar hemorrhage or foreign body.

Figure 4.

Axial MRI (T2 weighted image) scan at 1 hour after injury. Retrobulbar soft tissue of the right eye shows slightly increased signal intensity (arrow).

Figure 5.

Fields of gazes at three months after the injury show recovery of the extraocular muscle movement in all directions. Ptosis of the right upper eyelid improved.

Figure 6.

Diagrammatic representation of right superior orbital fissure with its contents (1. lacrimal nerve; 2. frontal nerve; 3. trochlear nerve; 4. superior branch of ophthalmic vein; 5. superior branch of oculomotor nerve; 6. nasociliary nerve; 7. inferior branch of oculomotor nerve; 8. abducens nerve; 9. inferior branch of ophthalmic vein; 10. optic nerve; 11. ophthalmic artery).

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