Orbital apex syndrome from bacterial sinusitis without orbital cellulitis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Neurology

Background:

• Orbital apex syndrome (OAS) involves cranial neuropathies affecting the orbital apex.
• Isolated bacterial sinusitis can be a rare cause of OAS.
• Severe vision loss is a critical complication of OAS.

Purpose of the Study:

• To present a case of OAS secondary to isolated bacterial sinusitis.
• To highlight the rapid progression of vision loss in this condition.
• To compare this case with existing literature on OAS from sinusitis.

Main Methods:

• Case report of a 63-year-old woman with OAS.
• Clinical presentation: rapidly declining visual acuity to no light perception.
• Comparative analysis with six similar cases.

Main Results:

• The patient experienced rapid vision deterioration despite appropriate treatment.
• Vision loss was permanent in this severe case.
• Infection extension into intracranial structures was prevented.

Conclusions:

• OAS can manifest with optic neuropathy due to orbital apex pathology.
• Early broad-spectrum antibiotic and antifungal therapy, alongside surgical intervention, is crucial.
• While vision loss may be irreversible, timely management can prevent intracranial spread.