| Identifier |
Orbital_Apex_syndrome |
| Title |
Orbital Apex Syndrome |
| Creator |
Andrew G. Lee, MD; Rachael Scott |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (RS) Class of 2020, Baylor College of Medicine, Houston, Texas |
| Subject |
Pathologies; Anatomy; Neuroanatomy |
| Description |
Dr. Lee lectures medical students on orbital apex syndrome. |
| Transcript |
Today we're going to be talking about the orbital apex syndrome and as you know the orbital apex is shaped like an ice cream cone on its side. The apex is here. So the optic nerve is passed through the optic canal and the cranial nerves in addition to the optic nerves CN II, CNIII, CNIV, CNV1, and CNVI all have to pass from the intracranial cavity into the intraorbital compartment through the superior orbital fissure and through the optic canal. So when we have a patient who has a lesion in the orbital apex we're looking for a combination of afferent and efferent problems. The afferent system (the optic nerve decreased acuity, decreased visual field, and the presence of the relative afferent pupillary defect either with a normal optic nerve, a swollen optic nerve, or if it's chronic the pale optic nerve) plus the efferent system (CN III, IV, and VI) which produces diplopia and ophthalmoplegia. We should test CNV1 to see if we are dealing with a lesion on this side of the line, orbital apex, or into the cavernous sinus which might include CNV2 or further intracranially CNV3. So the combination of any of these cranial nerves with or without proptosis pushing the eye forward is the sign of the ipsilateral orbital apex syndrome. The most common error is only imaging the head so if we only do an MRI of the head we might miss a subtle orbital lesion, and so normally a patient who has an orbital apex problem has to have both an MRI of the head and the orbit and typically we like to use fat suppression and gadolinium so that we can have the orbital apex lesion. Once the lesion is identified, if it's in the acute setting, we should search for inflammatory causes including granulomatous disease like sarcoidosis or IG4 or other orbital inflammatory pseudo tumors and we have to make sure it's not orbital real tumor. The location in the orbital apex makes it difficult to biopsy, so sometimes we'll just give empiric steroids if the patient is acute. If it's chronic, we're going to have to consult our colleagues in orbit and possibly neurosurgery for either a transorbital or transcranial approach to the lesion, but we would look elsewhere for another biopsy site before going into the orbital apex. So in summary if you have the combination of afferent, optic nerve afferent or sensory afferent trigeminal, and efferent ophthalmoplegia nerves CNIII, CNIV, or CNVI, we should be thinking about the orbital apex. |
| Date |
2019-03 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6v73xkm |
| Setname |
ehsl_novel_lee |
| ID |
1403729 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6v73xkm |
