ABSTRACT
Vision loss following sclerotherapy for facial vascular malformations (VMs) is a rare but detrimental complication. Here, we report a case of an 11‑year‑old boy with acute onset blepharoptosis, ophthalmoplegia, and blindness in his right eye after the 14th sclerotherapy session (percutaneous intralesional injection of sodium tetradecyl sulfate) for a right facial low‑flow VM without orbital involvement. Computed tomography angiography revealed no contrast enhancement in the right ophthalmic artery, superior ophthalmic vein, or extraocular muscles. He presented with the hallmarks of orbital infarction syndrome: Clear signs of anterior and posterior segment ischemia and disrupted arterial flow to the extraocular muscles. His blepharoptosis and eye movement improved 4 months later; however, he remained blind, and phthisis bulbi developed eventually. Thus, sclerotherapy for facial VM—even without orbital involvement––may result in severe ocular and orbital complications.
ABSTRACT
Orbital infarction syndrome is a rare complication of neurosurgical procedures. The authors recently experienced two patients suffered from acute proptosis, ophthalmoplegia, and blindness developed immediately after surgery for ruptured anterior communicating artery aneurysms. Both patients underwent standard frontotemporal craniotomies to clip their aneurysms. Retinal and choroidal nonperfusion, and ophthalmoplegia, which suggested hypoperfusion of the ophthalmic artery and its branches, consistent with the orbital infarction. We report two cases of orbital infarction syndrome and discuss possible mechanism with literature review.
Subject(s)
Humans , Aneurysm , Blindness , Choroid , Craniotomy , Exophthalmos , Infarction , Intracranial Aneurysm , Neurosurgical Procedures , Ophthalmic Artery , Ophthalmoplegia , Orbit , RetinaldehydeABSTRACT
Orbital infarction syndrome is a rare disorder resulting from ischemia of the intraocular and intraorbital structures due to hypoperfusion of the ophthalmic artery and its branches. The syndrome can occur with common carotid artery occlusion, orbital mucormycosis, giant cell arteritis and complications of surgery and manifests proptosis, ophthalmoplegia, and unilateral blindness. We recently experienced 5 cases of proptosis, ophthalmoplegia and unilateral blindness immediately after operation for 2 years. The cause of orbital infarction syndrome in these cases appeared to be the direct compression of orbit by the tightly retracted frontal scalp flap. We report and discuss possible mechanism with literature review.
Subject(s)
Blindness , Carotid Artery, Common , Exophthalmos , Giant Cell Arteritis , Infarction , Ischemia , Mucormycosis , Ophthalmic Artery , Ophthalmoplegia , Orbit , ScalpABSTRACT
PURPOSE: To report a case of orbital infarction syndrome induced by compression due to hard and bulky scalp flap. METHODS: Subject and METHODS: A 27-year-old female presented to our clinic, complaining of orbital pain, proptosis, ptosis, ophthalmoplegia and unilateral blindness, immediately after removal of cavernous hemangioma induced by the radiotherapy at 7 years earlier in right frontal lobe. Her scalp was hard and thick due to previous scar change and radiotherapy. Ophthalmologic examination demonstrated optic nerve injury, cranial nerve III, IV and VI palsy, diffuse retinal edema and cherry red spot in macula. Brain CT and MR angiography were done to evaluate the cause of orbital infarction. RESULTS: The cause of orbital infarction syndrome in this case appeared to be the compression of orbit by the hard and bulky scalp flap, and blindness was caused by the ischemia of intraorbital and intraocular structure.
Subject(s)
Adult , Female , Humans , Angiography , Blindness , Brain , Cicatrix , Exophthalmos , Frontal Lobe , Hemangioma, Cavernous , Infarction , Ischemia , Oculomotor Nerve , Ophthalmoplegia , Optic Nerve Injuries , Orbit , Papilledema , Paralysis , Prunus , Radiotherapy , ScalpABSTRACT
PURPOSE: To report a case of orbital infarction syndrome induced by compression due to hard and bulky scalp flap. METHODS: Subject and METHODS: A 27-year-old female presented to our clinic, complaining of orbital pain, proptosis, ptosis, ophthalmoplegia and unilateral blindness, immediately after removal of cavernous hemangioma induced by the radiotherapy at 7 years earlier in right frontal lobe. Her scalp was hard and thick due to previous scar change and radiotherapy. Ophthalmologic examination demonstrated optic nerve injury, cranial nerve III, IV and VI palsy, diffuse retinal edema and cherry red spot in macula. Brain CT and MR angiography were done to evaluate the cause of orbital infarction. RESULTS: The cause of orbital infarction syndrome in this case appeared to be the compression of orbit by the hard and bulky scalp flap, and blindness was caused by the ischemia of intraorbital and intraocular structure.
Subject(s)
Adult , Female , Humans , Angiography , Blindness , Brain , Cicatrix , Exophthalmos , Frontal Lobe , Hemangioma, Cavernous , Infarction , Ischemia , Oculomotor Nerve , Ophthalmoplegia , Optic Nerve Injuries , Orbit , Papilledema , Paralysis , Prunus , Radiotherapy , ScalpABSTRACT
Orbital infarction syndrome is defined as ischemia of all intraorbital and intraocular structures and is a rare disorder due to rich anastomotic vascularization of the orbit. It results in orbital and ocular pain, total ophthalmoplegia, anterior and posterior segment ischemia, and acute bindness. It can occur secondary to different mechanisms such as acute perfusion failure, systemic vasculitis, orbital cellulitis and vasculitis. We experienced a case of orbital infarction syndrome in a 61-year-old nonketotic diabetic woman who had developed paranasal sinusitis by mucormycosis and presented orbital cellulitis, multiple nerve paralysis, chorioretinal ischemia, facial necrosis around orbit and acute blindness. Prompt recognition of clinical pictures and rapid diagnosis is essential for early treatment of orbital infarction due to rhino-orbitocerebral mucormycosis because its progression is very rapid and fatal.
Subject(s)
Female , Humans , Middle Aged , Blindness , Diagnosis , Infarction , Ischemia , Mucormycosis , Necrosis , Ophthalmoplegia , Orbit , Orbital Cellulitis , Paralysis , Perfusion , Sinusitis , Systemic Vasculitis , VasculitisABSTRACT
Orbital infarction syndrome is defined as ischemia of all intraorbital and intraocular structures and is a rare disorder due to rich anastomotic vascularization of the orbit. It results in orbital and ocular pain, total ophthalmoplegia, anterior and posterior segment ischemia, and acute bindness. It can occur secondary to different mechanisms such as acute perfusion failure, systemic vasculitis, orbital cellulitis and vasculitis. We experienced a case of orbital infarction syndrome in a 61-year-old nonketotic diabetic woman who had developed paranasal sinusitis by mucormycosis and presented orbital cellulitis, multiple nerve paralysis, chorioretinal ischemia, facial necrosis around orbit and acute blindness. Prompt recognition of clinical pictures and rapid diagnosis is essential for early treatment of orbital infarction due to rhino-orbitocerebral mucormycosis because its progression is very rapid and fatal.
Subject(s)
Female , Humans , Middle Aged , Blindness , Diagnosis , Infarction , Ischemia , Mucormycosis , Necrosis , Ophthalmoplegia , Orbit , Orbital Cellulitis , Paralysis , Perfusion , Sinusitis , Systemic Vasculitis , VasculitisABSTRACT
Global orbital infarction is a rare disorder resulting from ischemia of the intraocular and intraorbital structures due to hypoperfusion of the ophthalmic artery and its branches. The syndrome can occur with common carotid artery occlusion, orbital mucormycosis, giant cell arteritis and complications of surgery and manifests protosis, ophthalmoplegia, and blindness. Protrusion of the eyeball(proptosis) is the result of expansion of tissue within orbital cavity and is the hallmark of orbital diseases. Expansion lesions may be benign or malignant and may arise from bone, muscle, nerve, blood vessel, or connective tissue. We report a case of combined ophthalmic artery occlusion, optic neuropathy, and third nerve palsy involving pupil in a 32-year-old patient with unilateral idiopathic proptosis following anterior choroidal aneurysm operation, and discuss possible mechanism with literature review.