Painful ophthalmoplegia. The Tolusa-Hunt syndrome

A 36-year-old man had the Tolusa-Hunt syndrome, an unusual cause of painful ophthalmoplegia with a neurologic deficit that may not be distinguishable from the many other disease processes that involve the orbital apex. Diagnosis was made by excluding the other causes, and there was a prompt response to high-dose steroid therapy, which prevents or minimizes any permanent neurologic deficit. Because of this and the fact that the otolaryngologist is often involved in the diagnosis and treatment of the many causes of painful ophthalmoplegia, it is important to be aware of this syndrome.