Orbital Apex Syndrome in Noninvasive Fungal Rhinosinusitis: a case report

Background Orbital apex syndrome (OAS) is characterized by multiple cranial nerve involvement leading to orbital pain or headache, vision loss, and ptosis. Typical clinical features are attributed to various tumors, vascular, infection, or sinus inflammatory diseases involving the orbital apex. Therefore, understanding the etiology of orbital tip syndrome and early identification and rapid treatment may help reduce related comorbidities. Case presentation We report the case of a 44-year-old Chinese female patient who presented with occipital headache, pain in the left eye, and sudden loss of vision in the left eye. Left orbital apex syndrome was diagnosed. The pain and ptosis worsened after glucocorticoid anti-inflammatory therapy and insulin control of blood glucose. CT scan was completed to consider the mass of the left sphenoid sinus, orbital apex, nasopharynx, and pterygopalatine fossa without excluding the possibility of tumor. In terms of treatment, functional endoscopic sinus surgery was performed. Headache, ptosis and pain disappeared at the latest follow-up 3 months after surgery, but left vision and ptosis did not improve significantly. Conlusion In showing the specific diagnosis and treatment process of this case, we should strengthen interdisciplinary knowledge and cooperation to prevent misdiagnosis. Early identification and prompt treatment of the cause of the orbital tip syndrome.