Orbital apex syndrome secondary to sinusitis

The orbital apex disorders include superior orbital fissure syndrome, cavernous sinus syndrome, and orbital apex syndrome. A 50-year female patient presented to hospital with complaints of right eye heaviness since 3 days, decrease vision since 5 days. Right sided headache, right eye blurred vision, ptosis of right eye lid for 1 week. On ophthalmologic examination ptosis and blurred vision in right eye seen. Visual acuity in right eye shows counting fingers close to fingers (CFCF), exotropia, extraocular movements reduced. Computed tomography paranasal sinus (CT PNS) plain and contract showed bilateral sphenoid, right maxillary and right posterior ethmoid sinusitis. Magnetic resonance imaging (MRI) brain showed ill-defined type 2 hyper intensity at right orbital apex and right cavernous sinus showing moderate enhancement with adjacent dural thickening and abnormal enhancement of anterior clivus suggestive of Infective etiology. Right anterior and posterior ethmoidectomy, right fronto-spehenoidectomy, right orbital decompression done.