Synonyms:

Anterior cavernous sinus syndrome, Rochon-Duvigneaud’s syndrome

Diagnosis:

This is a clinical diagnosis. Underlying causes are identified by investigations and clinical assessment. Dysfunction of cranial nerves oculomotor (III), trochlear (IV), abducens (VI) and first division of the trigeminal nerve (V1). Also sympathetic fibers may be involved causing a Horner syndrome (this becomes cavernous sinus syndrome). Exophthalmos and proptosis may occur. If the ophthalmic nerve (CN II) is involved then this is the orbital apex syndrome.

Investigations to consider:

CT if traumatic, otherwise as below
CT with & without contrast: hemangioma, AVMs
MRI: STIR MRI
Blood tests:

• FBC, U&E, fasting Glucose
• Vasculitic screen, ESR, CRP, ANCA, ANA, ENA
• SPEP, ACE
• Tests for infections: Borrelia serology, HIV

LP, CSF analysis
Biopsy if no response to steroids or early relapse: Rule out lymphoma

Causes of superior orbital fissure syndrome:

• Trauma
• Wegner granulomatosus
• Neoplastic:
  • Lymphoma, hemangioma,

Related articles:

• Approach to diplopia,
• Cavernous sinus syndrome, Oculmotor nerve CN III palsy, trochlear nerve CN IV palsy, abducens nerve CN VI palsy, Horner syndrome,