Curious case of a frozen pupil – Orbital apex syndrome

Abstract

Background

Orbital apex syndrome is a rare neurological disorder that occurs due to damage of cranial nerves at the apex of the orbit. Differentiating it from other ocular syndromes can be diagnostically challenging.

Report

We present a case of a 66-year-old female with metastatic rectal cancer who presented with worsening headache and vision loss in her right eye. She was noted to have a frozen eye and was diagnosed with orbital apex syndrome due to invasive fungal sinusitis. She was treated with debridement and antifungal therapy.

Why Should an Emergency Physician Be Aware of This?: Orbital apex syndrome is a rare condition requiring prompt diagnosis to minimize morbidity and mortality. Diagnosis relies on dedicated MRI of the orbits.