Facial nerve palsy as an unusual presentation of orbital apex syndrome

Abstract

Clinical cases of orbital apex syndrome are rare and most commonly manifested as a complication of fungal sinusitis, mainly in immunocompromised and poorly controlled diabetic patients. Rhino-orbital mucormycosis is a rare opportunistic, aggressive and fatal infection caused by mucor. The complex presentation of orbital apex syndrome not only poses a diagnostic challenge but also demands a multidisciplinary approach in patient management. Facial nerve palsy is an unusual presentation in orbital apex syndrome. We report the case of a 64-year-old diabetic patient presenting with ophthalmoplegia and visual loss associated with facial nerve palsy. Prompt ophthalmologic and otolaryngologic intervention with imaging and histologic confirmation, followed by early initiation of antifungal and antimicrobial therapy, were integral to preventing further complications, and reducing morbidity and mortality.