A case of orbital apex syndrome following cavernous sinus thrombosis and aneurysm of internal carotid artery secondary to paranasal fungal sinusitis

Purpose: To report a case of orbital apex syndrome following cavernous sinus thrombosis and aneurysm of internal carotid artery secondary to paranasal fungal sinusitis. Case and Clinical Course: An 82-year-old female developed fever followed, 2 days later, by swelling of the right eyelid and abducens palsy. She had a history of diabetes mellitus and carcinoma of the bladder. She developed, anoter 2 days later, ptosis of the right eyelid and total ophthalmoplegia. Magnetic resonance imaging led to the diagnosis of thrombosis of the right cavernous sinus, aneurysm of internal carotid artery at the site of cavernous sinus, and maxillary sinusitis. She was diagnosed with right orbital apex syndrome. She developed thrombosis extending from the left cavernous sinus to superior ophthalmic vein. Surgery of left maxillary sinusitis led to the detection of infection by aspergillus. The internal carotid was ligated as treatment of the aneurysm. There was no complication of surgery except persistent oculomotor palsy. Conclusion: The present case illustrates that orbital apex syndrome with infectious parasinusitis may be secondary to infectious aneurysm of internal carotid artery and cavernous sinus thrombosis.