Background and Objective

Orbital apex syndrome (OAS) is a serious and infrequent condition affecting the orbit with involvement of the optic nerve at the apex level. Diagnosis is often difficult and complex. Treatment includes supportive measures and eye protection, intravenous medications such as diuretics and/or corticosteroids and in some cases early surgical decompression is necessary. The prognosis will depend of the type and complexity of the lesion, but also on the precocity of medical or surgical treatment to avoid the irreversible damage of the intraorbital structures, derived from the increase of the pressure inside the compartment.

This paper aims to retrospectively review the cases of post-traumatic orbital apex syndrome diagnosed and treated in our hospital.

Methods

We conduct a retrospective review of our data base and describe the clinical and imaging diagnosis, the treatments performed, the different forms of evolution and the sequel of this syndrome.

Results

Three cases were registered and evaluated between 2007 and 2013. The ages of the patients ranged from 28 to 72 years; 2 men and 1 woman. The origin of the syndrome was in all cases high energy trauma on the orbital/malar region of the face. One patient did not require urgent surgical treatment, but the other 2 cases required early surgical treatment. In 2 cases no permanent sequel was documented, however 1 of them remained with irreversible blindness.

Conclusions

OAS is an infrequent entity related to high energy facial trauma. Diagnostic suspicion is essential for an adequate approach to treatment and is usually supported by radiological means available at any hospital. Treatment should be done early to avoid the permanent consequences. This should include stabilization of the patient ensuring airway permeability, highdose corticosteroids, prophylactic antibiotics and orbital revision surgery, which may be diagnostic-therapeutic in cases of total ophthalmoplegia with progressive exophthalmos.

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