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.