Visual loss from optic neuropathy and ophthalmoplegia involving multiple cranial nerves are the hallmarks of an orbital apex syndrome. Historically, the terms superior orbital fissure, orbital apex, and cavernous sinus have been used to define the anatomic locations of a disease process. However, the diagnostic evaluation and management is similar for each of these entities. High-resolution MRI is the preferred modality for evaluating most lesions involving the orbital apex. CT is a useful tool in the setting of trauma, to evaluate bone involvement, or when MRI is contraindicated. Although laboratory studies may be useful adjuncts in the diagnostic evaluation of lesions involving the orbital apex, surgical biopsy is often required for definitive diagnosis. Tolosa-Hunt Syndrome is a painful unilateral ophthalmoplegia caused by a granulomatous infiltration of nerves and muscles in the region of the superior orbital fissue. It is accompanied by partial or complete lesions of the third, fourth, fifth - ophthalmic division - and sixth cranial nerves. The ESR is usually raised. Treatment with steroids e.g. prednisolone is usually effective.



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