Superior Orbital Fissure Syndrome


Anterior cavernous sinus syndrome, Rochon-Duvigneaud’s syndrome


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
Blood tests:

  • FBC, U&E, fasting Glucose
  • Vasculitic screen, ESR, CRP, ANCA, ANA, ENA
  • 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,

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