A Longhorn-Induced Superior Orbital Fissure Syndrome: A Case Report

Superior orbital fissure syndrome is a rare condition with a well-defined clinical presentation. Key clinical features include ophthalmoplegia, ptosis, impaired extraocular muscle function, proptosis, and paresthesia of the frontal region. These symptoms arise from damage to the neurovascular contents in the fissure. Standard treatment protocol does not currently exist due to the rarity of the condition. Treatment options described include conservative observation, versus steroids or surgery.

Poster 133 A Longhorn-Induced Superior Orbital Fissure Syndrome: A Case Report Kimberly Nguyen1, Ama Sadaka2, Amina Malik2 1 University of Texas Health Science Center at Houston, Houston, Texas, USA, 2Houston Methodist Hospital, Houston, Texas, USA Introduction: Superior orbital fissure syndrome is a rare condition with a well-defined clinical presentation. Key clinical features include ophthalmoplegia, ptosis, impaired extraocular muscle function, proptosis, and paresthesia of the frontal region. These symptoms arise from damage to the neurovascular contents in the fissure. Standard treatment protocol does not currently exist due to the rarity of the condition. Treatment options described include conservative observation, versus steroids or surgery. Description of Case(s): We report an unusual case of a 74-year-old male who suffered a penetrating eyelid injury that occurred when a longhorn abruptly turned his head, broke the patient's eyeglasses, and hit him directly in the left eyelid. The patient had diplopia, ptosis, and pain, but no loss of consciousness. Ocular motility exam showed complete ophthalmoplegia in the left eye. External examination of the left eye revealed complete ptosis, moderate periorbital ecchymosis and edema, and a one centimeter laceration on the nasal upper eyelid with fat prolapse, indicating violation of the orbital septum. Computed tomography scan revealed mild left proptosis and a small, superonasal air pocket adjacent to the medial rectus postseptally, without evidence of globe injury. These findings where consistent with superior orbital fissure syndrome. Eyelid laceration exploration revealed no foreign body in the wound. The wound was irrigated with bacitracin solution and the skin was sutured. The patient did not receive steroids or surgical intervention. He showed progressive improvement of diplopia and extraocular motility throughout follow up, and his symptoms resolved completely without complications over a 4-month period. Conclusions, including unique features of the case(s): No other studies demonstrate upper eyelid laceration with superior orbital fissure syndrome caused by a longhorn injury, resolving completely with conservative management. This case demonstrates that observation alone may be effective and prevents risks associated with steroid use and surgical complications in geriatric patients. References: None. Keywords: Orbit, Ocular Motility Financial Disclosures: The authors had no disclosures. Grant Support: None. 2018 Annual Meeting | 177