Blindness caused by orbital apex syndrome due to uncertain inflammatory condition following functional endoscopic sinus surgery

Case The patient first presented with progressive vision loss as well as double vision, head ache and frontal loss of sensibility in July 2023. Four weeks ahead he underwent sinus surgery, the histological and microbiological examinations brought up the presence of streptococcus constallatus. Due to complete vision loss, ophthalmolplegia and frontal loss of sensibility he was diagnosed with orbital apex syndrome of unknown cause. CT and MRI scans showed a compression of the right optic nerve by an expanding leasion around the posterior orbital funnel. More scans as well as microbiological examinations of the right sphenoid sinus were performed and displayed Pseudomonas aeruginosa and MRSA. The patient was therefore treated with intravenous cefepime and linezolid. On the 7th of September a transnasal navigated biopsy of the unclear orbital mass was performed, the histological results showed granulomatous plasma cell-rich infiltration without signs of malignancy. Tests on HSV, CMV, EBV, treponema pallidum and fungal infiltration came out negative. Neurological and rheumatological consultations recommended a treatment with prednisolone, which led to a constant improvement of the symptoms as well as a shrinking of the orbital mass in following MRI scans. Recent findings point towards a possible IgG4-related diesease. More follow-ups as well as the histological examination from the first sinus surgery will be considered to provide more information on a possible diagnosis.

Publication History

Article published online:
19 April 2024