An Eye Opener for a Blinding Disease-Orbital Infarction Syndrome.

Orbital infarction syndrome (OIS) is a disease of rare occurrence owing to the rich orbital vascular anastomotic network. We describe a case of a middle-aged female who presented with an acute left middle cerebral artery (MCA) territory infarct with left terminal internal carotid artery and MCA occlusion, underwent emergency mechanical thrombectomy, and developed painful loss of vision shortly after diagnosed as OIS based on clinical and radiological findings. The rarity and severity of OIS, especially in the setting of mechanical thrombectomy, warrant radiologists to be aware of this entity to ensure preventive measures or aid in prompt diagnosis to institute timely treatment.

Orbital Infarction Syndrome Following Mechanical Thrombectomy Secondary to Embolization in New Territory.

BACKGROUND: Orbital infarction syndrome (OIS) is a rare entity defined as ischemia of all intraorbital and intraoccular structures including the optic nerve, extraocular muscles, and orbital fat. This entity is rare due to rich anastomotic orbital vascularization from both the internal carotid artery and external carotid artery. We report a case of a patient who suffered emboli to previously nonaffected territories to the ophthalmic artery and external carotid artery, which resulted in orbital infarction syndrome, and describe techniques to avoid such complications. CASE DESCRIPTION: A 66-year-old male presented to our institution with an acute ischemic stroke secondary to occlusion of the internal carotid artery terminus and M1 segment. The vessel was revascularized after 1 pass using a stent retriever. Postoperative angiography demonstrated sluggish flow in the distal right ophthalmic artery, as well as occlusion of the distal external carotid artery. Twenty-four hours following the procedure, the patient was noted to have complete ophthalmoplegia of the right eye, proptosis, and conjunctival chemosis. Computed tomography angiography demonstrated persistent occlusion of the distal right ophthalmic artery and external carotid artery. The right optic nerve was swollen, as were all extraocular muscles. A final diagnosis of orbital infarction syndrome was made given the clinical presentation, imaging findings, and occlusion of all vascular supply to the orbit on both conventional angiography and 24-hour computed tomography angiography. CONCLUSIONS: OIS is a rare entity that has not been previously described as a complication of mechanical thrombectomy for acute ischemic stroke. OIS should be considered when patients present with blindness, orbital pain, and total ophthalmoplegia post thrombectomy.

Orbital Infarction Syndrome after Surgery for Ruptured Anterior Communicating Artery Aneurysm: Case Reports / 대한뇌혈관외과학회지

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.

Five Cases of Orbital Infarction Syndrome Caused by Compression of Surgical Scalp Flap / 대한뇌혈관외과학회지

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.

A case of Orbital Infarction Syndrome Caused by Compression of Bulky Bicoronal Scalp Flap

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.

A case of Orbital Infarction Syndrome Caused by Compression of Bulky Bicoronal Scalp Flap

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.

A Case of Orbital Infarction Syndrome in Rhino-Orbitocerebral Mucormycosis

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.

A Case of Orbital Infarction Syndrome in Rhino-Orbitocerebral Mucormycosis

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.

A Case of Orbital Infa rction Syndrome after Surgery for Intracranial Aneurysm

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.