ePoster listing and sessions

Topic: ESOPRS 2021 ePoster sessions
Time: Sep 17, 2021 16:00 Amsterdam, Berlin, Rome, Stockholm, Vienna, 15:00 London

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A Multi-Disciplinary Approach to Orbital Apex Pathology

Author: Matthew Gillam
ePoster Number: 234

Purpose

Isolated Orbital Apex (OA) pathology is rare, arises from various aetiologies and can cause devastating visual morbidity. Traditional ophthalmological consensus management is empirical, usually immunosuppressive treatment, due to the potential risk of collateral damage during biopsy, contradicting the mantra of treatment after histological diagnosis.

Methods

We undertook a multicentre retrospective case series of 18 cases of superior orbital fissure syndrome (SOFS) and orbital apex syndromes (OAS). Data were collected on patient demographics, presentation, diagnosis, management and outcomes. 11 non-traumatic cases underwent surgical biopsy/excision, 7 iatrogenic/traumatic cases were managed conservatively.

Results

6 males and 12 females aged between 17-78 were included, presenting with symptomatic diplopia (12 patients), visual loss (8 patients), proptosis (5 patients) and headaches (3 patients). Aetiology included: 3 patients with trauma; 4 post-surgical; 2 with IgG4 disease; 2 with orbital histiocytosis and 7 with other diagnoses. All 7 traumatic and post-surgical cases showed at least partial improvement in visual acuity and cranial nerve involvement without further surgery. All 11 cases with orbital apical lesions underwent endoscopic biopsy. There was no deterioration in vision or ocular motility associated with the surgery. Subsequent management tailored to the histological diagnosis of these 11 patients resulted in improved vision in 8 patients and ocular motility in 7 patients.

Conclusion

The causes of OAS and SOFS are multiple and varied. Many OA lesions medial to the optic nerve can undergo biopsy safely enabling targeted therapy, instead of empirical immunosuppression. The outcomes of traumatic and iatrogenic OA patients are generally good without intervention.

Additional Authors

Abstract ID: 21-127