Thread by @MayoClinicINFD

#MayoIDQ: 86M DM

2 wk of R ear pain / nasal discharge

Now: R frontal HA, facial pain, vision loss

PE: R ptosis, CN III, IV, VI palsies, purulence R middle meatus

CT: R sided paranasal sinusitis w/ phlegmonous extension to orbital apex

What is DDx, work up and etiology?

2/
Diagnosis: Orbital Apex Syndrome

S/S due to involvement of structures in orbital apex: most common vision loss and painful / limited eye movement

CN palsies
* Optic nerve
* Oculomotor nerve
* Trochlear nerve
* First division of trigeminal nerve
* Abducens nerve

3/
DDx (overlapping symptoms) of orbital apex syndrome

1. Cavernous sinus thrombosis
2. Superior orbital fissure syndrome

ncbi.nlm.nih.gov/pmc/articles/P…

4/
General Causes of Orbital Apex Syndrome
1. Infection
2. Inflammatory/ vasculitis
3. Neoplastic
4. Trauma

What are the most common infectious pathogens? (Bacteria, Fungus, Virus, Parasite)

5/
The patient had ENT / ophthalmologic surgical debridement and specimens were collected for culture and histopathology.

Culture: MSSA 4+
Histopath (photo)

What do you use for Rx?

86M diabetic with orbital apex syndrome. See thread for details. Culture and histopathology shown. In addition to MSSA Rx, what is your Rx recommendation?

6/
Case diagnosis: Orbital Apex Syndrome

Culture of sinus and biopsy:
#Staphylococcus aureus
#Aspergillus fumigatus

Rx:
Cefazolin
#Voriconazole
ENT debridement