Orbital Apex Syndrome after Uneventful Phacoemulsification

Jae Ho Yoo; Ki Yup Nam; Seung Uk Lee; Sang Joon Lee

doi:10.3341/jkos.2016.57.12.1994

Journal List > J Korean Ophthalmol Soc > v.57(12) > 1010494

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Yoo, Nam, Lee, and Lee: Orbital Apex Syndrome after Uneventful Phacoemulsification

Case Report

J Korean Ophthalmol Soc 2016;57(12):1994-1997.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.12.1994

Orbital Apex Syndrome after Uneventful Phacoemulsification

Jae Ho Yoo, MD¹, Ki Yup Nam, MD, PhD¹, Seung Uk Lee, MD, PhD¹, Sang Joon Lee, MD, PhD^1,²

¹Department of Ophthalmology, Gospel Hospital, Kosin University College of Medicine, Busan, Korea

²Institute for Medicine, Kosin University College of Medicine, Busan, Korea

Address reprint requests to Sang Joon Lee, MD, PhD Department of Ophthalmology, Kosin University Gospel Hospital, #262, Gamcheon-ro, Seo-gu, Busan 49267, Korea Tel: 82-51-990-6228, Fax: 82-51-990-3026 E-mail: hhiatus@gmail.com

Received 4 May 2016 Revised 17 October 2016 Accepted 22 November 2016

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.

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.

Keywords: Ocular ischemic syndrome, Orbital apex syndrome, Idiopathic orbital inflammatory disease

References

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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.

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