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Jurnal Oftalmologi Indonesia

ISSN 1693-2587

Vol. 5 / No. 3 / Published : 2001-01

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Original Article :

Bilateral orbital apex syndrome

Author :

  1. Dicky Hermawan*1
  2. Elisabeth Srisubekti*2
  3. Prijanto *3
  1. Dosen Fakultas Kedokteran

Abstract :

The purpose of this study is to report a rare case of secondary bilateral complete ophthalmoplegia due to a malignancy or infectionof the cavernous sinus and orbital apex. 52 year-old woman had suffered from blurred vision and ocular pain for 5 weeks. Examinationrevealed negative light perception, ptosis, complete ophthalmoplegia and ocular pain on both eyes. Magnetic resonance imaging (MRI)showed the presence of a mass on cavernous sinous, spread to right and left sphenoidalis and ethmoidalis sinuses. Involvement of thechiasma, right optic nerve, medial and lateral rectus muscles of the right eye and right temporofrontalis lobe was observed. There was0.30 cm midline shift to the left. Differential diagnosis included nasopharyngeal carcinoma, lymphoma, or an infectious process. Thepatient wasn’t operated because the position of the mass was in the midline and had a high risk to operate. The possible therapies werechemotherapy or radiotherapy with biopsy initially to know histological diagnosis. A combination of surgical, medical, and radiologicalintervention may be required to manage rhino-cerebral diseases responsible for orbital apex syndrome. Advances in neurologic imaging,histologic examination of tissue obtained from a biopsy may ultimately be necessary to obtain a definitive diagnosis.

Keyword :

bilateral ophthalmoplegia, cavernous sinuses, orbital apex syndrome,


References :

  1. Cibis G.W., et al, (2001). Fundamentals and Principles of Ophthalmology. San Francisco : The Foundation of the American Academy of Ophthalmology
  2. Riordan-Eva P., Whitcher J.P. 2004. Vaughan and Asbury’s, (2004). General Ophthalmology. Singapore : Mc Graw Hill
  3. Kanski J.J. 2003, (0000). Clinical Ophthalmology A Systematic Approach, 5th ed. London : Butterworth Heinemann


   


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