Superior orbital fissure syndrome after deep lateral orbital wall decompression in Graves’ ophthalmopathy

ABSTRACT

Purpose

The superior orbital fissure contains cranial nerves III, IV, VI, and V1 with their three branches: frontal, lacrimal, and nasociliary. Superior orbital fissure syndrome (SOFS) is rare and can occur as a result of compression of these nerves due to trauma, bleeding, or inflammation in the retrobulbar space, but no cases of SOFS after deep lateral orbital wall decompression (DLOWD) have been reported. The aim of this paper is to describe this pathology, its possible causes, management, and outcome.

Methods

Retrospective study of 575 DLOWD in patients with disfiguring exophthalmos due to Graves’ ophthalmopathy performed in our hospital between 2010 and 2023. Three cases of postoperative SOFS were identified based on clinical presentation, history, physical examination, and radiological study. All patients were observed for a minimum of 12 months.

Results

SOFS was diagnosed with the presence of ophthalmoplegia, ptosis, fixed and dilated pupils, hypo/anesthesia of the upper eyelid and forehead, loss of corneal reflex, and no loss of vision after DLOWD. Fractures, edema, and hemorrhages were excluded. They were treated with high-dose intravenous steroids and the patients recovered completely.

Conclusions

DLOWD challenges orbital surgeons because it requires removing bones near the globe or neurovascular structures. SOFS may occur due to the proximity and increased pressure on these structures.

KEYWORDS:

• Deep lateral orbital wall decompression
• Graves’ ophthalmopathy
• orbital apex syndrome
• orbital fissure syndrome
• superior orbital fissure syndrome

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Author contributions

ÁB-G and M-DL-L collected the data, were major contributors in writing the manuscript, designing the project, and revising the manuscript for important intellectual content. ES helped to analyse the radiological data. EM-G helped revise the manuscript. All authors edited and reviewed the manuscript.

Data availability statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Ethical approval

All procedures performed in this study involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.