Traumatic orbital apex syndrome following penetrating ocular injury: a case report

Background: The ophthalmic branch of the trigeminal nerve (V1), the optic (II), oculomotor (III), trochlear (IV), abducens (VI), and other cranial nerves are frequently affected by orbital apex syndrome (OAS), also known as Jacod syndrome. It can be caused by inflammatory, vascular, neoplastic, infectious, or traumatic factors; trauma is a less frequent cause. Case Presentation: After suffering penetrating ocular trauma from a metallic object, a 40-year-old man arrived with total ptosis of the right eye and visual loss. The examination showed complete ophthalmoplegia, a grade 4 RAPD, medial canthal laceration with subconjunctival hemorrhage, and hand motion vision in the right eye. Fractures and intraocular foreign bodies were ruled out by CT orbit. Intravenous methylprednisolone was part of the initial treatment. The B-scan ultrasonography showed nothing unusual. An MRI revealed orbital apex involvement, confirming traumatic OAS. The patient was placed under close observation with the possibility of future intervention, and steroid therapy was stopped. Conclusion: this case demonstrates the classic characteristics of traumatic OAS, such as ophthalmoplegia and vision loss brought on by involvement of the cranial nerve. Conservative treatment may be adequate for some patients, even though surgical decompression is recommended in specific situations, particularly when the optic nerve is compressed. It is still debatable whether early high-dose corticosteroids are beneficial in traumatic optic neuropathy. While more research is required to standardize care in traumatic OAS, prompt diagnosis and customized treatment planning are essential.