Superior Orbital Fissure Syndrome

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The superior orbital fissure syndrome is a complex neurological clinical picture with failures of the cranial nerves III ( N. oculomotorius ), IV ( N. trochlearis ) and VI ( N. abducens ), as well as the ophthalmic nerve as the first branch of the cranial nerve V ( N. . trigeminus ). The localization of the disturbances is at a bone gap between the rear part of the eye socket ( orbit ) and the middle cranial fossa , the fissura superior orbitalis . It is eponymous for the syndrome.

causes

The superior orbital fissure is located between the small and large wings of the sphenoid bone and is the place where the cranial nerves mentioned, among other things, pass from the skull into the eye socket. Disorders are usually triggered by processes that occupy space, such as tumors ( meningiomas , craniopharyngiomas , metastases ) or aneurysms and thromboses of the internal carotid artery or traumatic injuries. Inflammatory processes can also be responsible for corresponding lesions .

Symptoms

The symptoms are very complex and varied because of 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 partial or complete drooping of the eyelid ( ptosis ). Disturbances in the ability to focus close ( accommodation ) and pupillary rigidity with miosis can also occur. Another typical sign is a massive headache in or behind the eye socket. In some cases, an exophthalmos occurs. It is also possible to remove the corneal sensitivity.

Diagnosis

The clinical signs can be verified by means of strabological examination methods and the causes can usually be determined by imaging methods such as magnetic resonance imaging (MRT) and cranial computed tomography (CCT), possibly also by lumbar puncture . The orbital apex syndrome is to be differentiated from the differential diagnosis as an extension of the superior orbital fissure syndrome with involvement of the cranial nerve II, the optic nerve , with optic atrophy and specific visual field defects ( scotomas ), as well as the cavernous sinus syndrome .

therapy

A therapy primarily pursues the neurological treatment of the causal disease triggers. A symptomatic attempt at therapy can be carried out with oral glucocorticoids .

literature

  • Herbert Kaufmann (Ed.): Strabismus. 3rd, fundamentally revised and expanded edition. Georg Thieme, Stuttgart et al. 2003, ISBN 3-13-129723-9 .
  • Theodor Axenfeld (founder), Hans Pau (ed.): Textbook and atlas of ophthalmology. With the collaboration of Rudolf Sachsenweger and others 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 evidence

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