Orbital apex syndrome associated with fractures of the inferomedial orbital wall

Although trauma is one of the main causes of orbital apex syndrome (OAS), reports of OAS associated with orbital fractures are relatively rare. We recently treated two patients who sustained severe visual impairment with damage to multiple cranial nerves (third to sixth) associated with inferomedial orbital wall fractures. In these patients, posterior movement of the globe caused neuropathy of the cranial and optic nerves by posterior globe edema and hemorrhage, or direct impact between the globe and wall, which might then have induced OAS in the cases described in this report. Steroid therapy was unsuccessful for optic neuropathy due to the delay between injury and administration. When treating patients with inferomedial orbital blowout fractures due to globe-to-wall contact, it is necessary to routinely assess and monitor visual acuity since there may be a delay between the injury and OAS onset.