J Korean Ophthalmol Soc > Volume 59(3); 2018 > Article
Journal of the Korean Ophthalmological Society 2018;59(3):295-300.
DOI: https://doi.org/10.3341/jkos.2018.59.3.295    Published online March 15, 2018.
A Case of Orbital Apex Syndrome with Central Retinal Artery and Vein Occlusion Following Trauma.
Mirinae Jang, Sang Yoon Lee, Hye Jin Lee, Eun Kyoung Lee
Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea. righthanded8282@gmail.com
외상에 의해 발생한 망막중심동맥과 중심정맥의 폐쇄와 이에 동반된 안와첨증후군 1예
장미리내⋅이상윤⋅이혜진⋅이은경
제주대학교 의학전문대학원 안과학교실
Correspondence:  Eun Kyoung Lee,
Email: righthanded8282@gmail.com
Received: 26 October 2017   • Revised: 22 December 2017   • Accepted: 19 February 2018
Abstract
PURPOSE
To report a case of orbital apex syndrome (OAS) combined with central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) following blunt trauma. CASE SUMMARY: A 4-year-old female visited the hospital following a traffic accident. She was admitted because of multiple fractures of the skull and pneumocephalus. On day 5, she was referred to us with decreased visual acuity in her right eye. Her initial visual acuity was hand motions in the right eye and 0.8 in the left eye. The right eye showed a dilated pupil, ptosis, and total ophthalmoplegia, and the left eye showed limited abduction. A fundus examination revealed multiple retinal hemorrhages, tortuous veins, and an edematous white retina with a cherry-red spot in the right eye. Brain magnetic resonance imaging revealed an entrapped right optic nerve because of bony fragments in the orbital apex. The patient was diagnosed with OAS accompanied by CRAO and CRVO in the right eye, and with traumatic abducens nerve palsy in the left eye. After 6 months, the visual acuity was hand motions, and the fundus examination showed absorbed retinal hemorrhages, pale discs, and general retinal thinning of the right eye. Ptosis of the right eye and extraocular muscle movement of both eyes were improved. CONCLUSIONS: Combined CRAO and CRVO following trauma is very rare and is even more rarely associated with OAS. It is important for clinicians to be aware of the potential for central retinal vessel occlusions and OAS in cases of blunt ocular trauma.
Key Words: Blunt ocular trauma;Central retinal artery occlusion;Central retinal vein occlusion;Orbital apex syndrome


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