<%server.execute "isdev.asp"%> Orbital apex syndrome: a clinico-anatomical diagnosis Saini L, Chakrabarty B, Kumar A, Gulati S - J Pediatr Neurosci
home : about us : ahead of print : current issue : archives search instructions : subscriptionLogin 
Users online: 262      Small font sizeDefault font sizeIncrease font size Print this page Email this page

  Table of Contents    
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 336-337

Orbital apex syndrome: a clinico-anatomical diagnosis

1 Division of Child Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
2 Department of Radiodiagnosis, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India

Date of Submission08-May-2020
Date of Decision04-Jul-2020
Date of Acceptance15-Jul-2020
Date of Web Publication06-Nov-2020

Correspondence Address:
Prof. Sheffali Gulati
Centre of Excellence and Advanced Research on Childhood Neurodevelopmental Disorders, Division of Child Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpn.JPN_114_20

Rights and Permissions



An 8-month-old girl presented with fever, restricted left eye movements and increasing proptosis for 8 days. On examination she had left orbital cellulitis, relative afferent pupillary defect and ophthalmoplegia. Contrast-enhanced magnetic resonance imaging (MRI) brain with orbits revealed orbital apex syndrome (OAS) with cavernous sinus thrombosis. Orbital apex is located posteriorly in the orbit and characterised by involvement of cranial nerves II, III, IV, VI and ophthalmic division of Vth nerve. The close clinico-anatomical differentials of OAS are cavernous sinus and superior orbital fissure syndrome. The current case was treated successfully with intravenous antibiotics and anticoagulation therapy.

Keywords: Cavernous sinus, orbital apex, superior orbital fissure

How to cite this article:
Saini L, Chakrabarty B, Kumar A, Gulati S. Orbital apex syndrome: a clinico-anatomical diagnosis. J Pediatr Neurosci 2020;15:336-7

How to cite this URL:
Saini L, Chakrabarty B, Kumar A, Gulati S. Orbital apex syndrome: a clinico-anatomical diagnosis. J Pediatr Neurosci [serial online] 2020 [cited 2023 Feb 5];15:336-7. Available from: https://www.pediatricneurosciences.com/text.asp?2020/15/3/336/300036

A premorbidly normal, 8-month-old girl, presented with fever, progressive proptosis, and restriction of left-sided ocular movements of 1 week. Salient features on examination were left-sided orbital cellulitis, relative afferent pupillary defect, and ophthalmoplegia. Clinically, a possibility of left orbital cellulitis with involvement of left orbital apex and/or cavernous sinus was kept.

Contrast-enhanced magnetic resonance imaging (MRI) of the brain and orbit revealed inflammation of the left orbit with extension to the optic nerve, orbital apex, and cavernous sinus, confirming the diagnosis of orbital apex syndrome (OAS) with additional left cavernous sinus thrombosis [Figure 1].
Figure 1: Contrast-enhanced axial (A, B) and coronal (C) MRI of the brain shows proptosis of left eye globe with enhancing inflammation in left orbit and at the orbital apex (arrow in B) with extension into left cavernous sinus (arrows in A and C)

Click here to view

Orbital apex is anatomically located in the posterior part of a pyramidal-shaped orbit.[1] The OAS is characterized by the involvement of cranial nerves II, III, IV, VI, and ophthalmic division of Vth.[2] Owing to the close anatomical proximity, it needs to be differentiated from superior orbital fissure syndrome (SOFS) and cavernous sinus syndrome (CSS). The presence of optic nerve involvement differentiates OAS from the other two. Involvement of sympathetic fibers and maxillary division of trigeminal nerve differentiates CSS from the others.[3] This case had an involvement of orbital apex with the extension of the disease process to cavernous sinus.

The OAS can be caused by infective, inflammatory, endocrine, neoplastic, and vascular causes.[4] Management revolves around the treatment of the underlying cause and tissue diagnosis, whenever required.[1],[2] This case responded to 12 weeks of intravenous antibiotics and subcutaneous low-molecular-weight heparin for the associated cavernous sinus thrombosis.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Badakere A, Patil-Chhablani P Orbital apex syndrome: a review. Eye Brain 2019;11:63-72.  Back to cited text no. 1
Yeh S, Foroozan R Orbital apex syndrome. Curr Opin Ophthalmol 2004;15:490-8.  Back to cited text no. 2
Kline LB The Tolosa-Hunt syndrome. Surv Ophthalmol 1982;27:79-95.  Back to cited text no. 3
Goyal P, Lee S, Gupta N, Kumar Y, Mangla M, Hooda K, et al. Orbital apex disorders: imaging findings and management. Neuroradiol J 2018;31:104-25.  Back to cited text no. 4


  [Figure 1]

This article has been cited by
1 Bridging the Gap between Ophthalmology and Emergency Medicine in Community-Based Emergency Departments (EDs): A Neuro-Ophthalmology Guide for ED Practitioners
Kristina Thomas, Cindy Ocran, Anna Monterastelli, Alfredo A. Sadun, Kimberly P. Cockerham
Clinics and Practice. 2021; 11(4): 919
[Pubmed] | [DOI]


Print this article  Email this article
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (405 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

    Article Figures

 Article Access Statistics
    PDF Downloaded61    
    Comments [Add]    
    Cited by others 1    

Recommend this journal