Superior Orbital Fissure Syndrome due to Metastatic Prostatic Malignancy – A Case Report
Abstract
A 56 years old male patient, a known case of prostatic malignancy with skeletal metastasis presented with ptosis, exotropia, diminished pupillary reflex and limitations in extra-ocular movements of left eye. MRI brain revealed diffuse skull base and leptomeningeal metastasis. Whole body CT scan showed metastasis in ribs, scapula and in pelvic bones. He was diagnosed to have superior orbital fissure syndrome due to metastatic prostatic malignancy and was offered steroids and radiotherapy.
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Introduction
Superior Orbital Fissure syndrome(SOFS), first described by Hirschfield in 1858,1 is an infrequently described and reported symptom Complex. Superior orbital fissure syndrome (SOFS) is a rarely encountered entity in clinical practice. It can be caused due to trauma, infection, inflammation, neoplasms, and idiopathic causes. In most of the cases it presents as an extraocular muscle weakness. The causes for paresis may be direct compression, infiltration and ischemia. We report a case of SOFS due to metastatic prostatic malignancy.
Conclusion
Ophthalmologist should take a careful history including neurological symptoms foramen with cranial nerve palsies. Those patients with multiple progressive or persistent cranial nerve palsies. Further investigation including PSA levels and possibly a contrast CT scan with bone windows to rule out underlying causes of these symptoms.