Traumatic Orbital Apex Syndrome With Acute Orbital Compartment Syndrome Secondary to Facial Fractures: A Case Report

Orbital apex syndrome (OAS) is a rare yet severe complication of facial trauma, characterized by acute visual loss and ophthalmoparesis due to optic neuropathy and involvement of the superior orbital fissure's (SOF) emerging structures. When associated with acute orbital compartment syndrome (AOCS), OAS constitutes a medical emergency due to the high risk of irreversible visual loss, requiring emergent fracture reduction and decompression. We present a case of a 39-year-old male admitted following facial and cranioencephalic trauma with loss of consciousness after a fall from a 3 m height. On admission, he exhibited proptosis, eyelid ptosis, anisocoria with fixed mydriasis, ophthalmoparesis, decreased visual acuity, and elevated intraocular pressure. CT imaging revealed a left zygomaticomaxillary complex (ZMC) fracture with orbital floor involvement, SOF narrowing due to fracture fragments, and ocular globe tenting. A diagnosis of OAS and AOCS secondary to SOF narrowing was made, and the patient underwent emergent fracture reduction and fixation with immediate intraoperative decompression. Postoperatively, the patient demonstrated favorable evolution with resolution of proptosis, full recovery of ocular motility, and full visual recovery. To our knowledge, traumatic orbital apex syndrome associated with acute orbital compartment syndrome has been rarely reported in the literature, and this case illustrates the potential benefits of prompt, coordinated multidisciplinary intervention. Nevertheless, conclusions drawn from a single case must be interpreted with caution, as the rarity of this condition limits the availability of high-level evidence and precludes definitive treatment guidelines.