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Fissura-orbitalis-superior-syndrome

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The fissura orbitalis superior syndrome is a complex neurological clinical picture with deficits of the cranial nerves III (oculomotor nerve), IV (trochlear nerve) and VI (abducens nerve), as well as of the ophthalmic nerve as the first branch of the cranial nerve V (trigeminal nerve). The localization of the disorders is at a bony fissure between the posterior part of the orbit and the middle cranial fossa, the fissura orbitalis superior. It gives the syndrome its name.

Causes

The superior orbital fissure is located between the lesser and greater sphenoid wings and is the site of passage of the aforementioned cranial nerves, among others, from the skull into the orbit. Disorders are usually caused by space-occupying processes such as tumors (meningiomas, craniopharyngeomas, metastases) or aneurysms and thromboses of the internal carotid artery or traumatic injuries. Inflammatory processes can also be responsible for corresponding lesions.

Symptoms

The symptomatology is very complex and varied due to the involvement of several cranial nerves. Since all eye muscle nerves are affected, there are generally massive movement disorders of the eyes up to total ophthalmoplegia, as well as a partial or complete drooping of the eyelid (ptosis). There may also be disturbances in the ability to see close up (accommodation) and pupillary rigidity with miosis.[1] Another typical sign is a massive headache in the area of the eye socket or behind it. In some cases an exophthalmus occurs. A loss of corneal sensitivity is also possible.

Diagnostics

The clinical signs can be verified by means of strabological examination procedures and the causes can usually be determined by imaging procedures such as magnetic resonance imaging (MRI) and cranial computed tomography (CCT), possibly also by lumbar puncture. Differentially, the orbital apex syndrome should be distinguished as an extension of the fissura orbitalis superior syndrome with involvement of the cranial nerve II, the optic nerve, with optic atrophy and specific visual field defects (scotomas), as well as the sinus cavernosus syndrome.

Therapy

A therapy primarily pursues the neurological treatment of the causal disease triggers.
Symptomatic therapy can be attempted with oral glucocorticoids.

Literature

  • Herbert Kaufmann (Ed.): Strabismus. 3., fundamentally revised and expanded edition. Georg Thieme, Stuttgart et al. 2003, ISBN 3-13-129723-9.
  • Theodor Axenfeld (founder), Hans Pau (ed.): Lehrbuch und Atlas der Augenheilkunde. With the collaboration of Rudolf Sachsenweger et al. 12th, completely revised edition. Gustav Fischer, Stuttgart et al. 1980, ISBN 3-437-00255-4.
  • P. Berlit, K. Tornow: Differential diagnosis of superior orbital fissure syndrome. In: Swiss Medical Weekly. Vol. 118, No. 30, 1988, ISSN 0036-7672, pp. 1104-1109, PMID 3175562.

Individual references

  1. Rudolf Sachsenweger (ed.): Neuroophthalmology. 3., revised edition. Thieme, Stuttgart et al. 1982, ISBN 3-13-531003-5, p. 252 ff.