Post-Viral Orbital Inflammation Presenting as a 3rd Cranial Nerve Palsy
Author: Miguel Kurc
Base Hospital / Institution: Manchester Royal Eye hospital
ePoster presentation
Abstract ID: 24-452
Purpose
A 35 year-old male presented to the Emergency Department with an 11 day history of mild right-sided orbital pain, diplopia and blurring of vision in the right eye only. This was preceded by an episode of likely viral sinusitis which was treated conservatively. The patient reported a similar episode 8 years prior which resolved spontaneously.
Methods
Full ophthalmological examination, imaging and blood tests performed in emergency department and in follow-up oculoplastics clinics
Results
Examination revealed right mydriasis, partial right upper lid ptosis and limitation in abduction and adduction of the right eye. There was no evidence of proptosis or optic nerve dysfunction. Mild right periorbital swelling was noted, but the eye remained white. A CT angiogram of the Circle of Willis was normal. An MRI head and orbits revealed high T2 signal and diffuse enhancement of the right lateral rectus and tendon with crowding of the orbital apex but no definitive compression on the optic nerve. Orbital inflammatory blood testing was within normal limits. The patient was observed closely with the option of biopsy should his symptoms progress. The anisocoria spontaneously resolved within 2 days. After 4 weeks, the patients’ symptoms and signs had fully resolved without any treatment.
Conclusion
Following a literature search, we consider this to be a unique case of post-viral orbital inflammation presenting as a pupil-involving 3rd cranial nerve palsy. Non-specific orbital inflammation (previously orbital pseudotumour) was first described in 19031 by Gleason and the pathophysiology remains largely unknown. Infectious agents have been implicated in immunological dysregulation and the emergence of orbital inflammation2. We have found cases with similar clinical presentation but distinct clinical course and aetiology3,4,5. Our case had a preceding viral illness with no other risk factors identified. We propose the inflamed right lateral rectus muscle temporarily caused restricted right eye abduction and compression of the intra-orbital 3rd cranial nerve leading to ipsilateral mydriasis, ptosis and limited adduction.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Nikolitsa | Koutropoulou | Manchester Royal Eye hospital |
| James | Laybourne | Manchester Royal Eye hospital |
