Orbital apex syndrome

Last revised by Dr Mostafa El-Feky on 23 Apr 2022

Orbital apex syndrome, also known as Jacod syndrome, is a constellation of clinical findings, presenting as a result of several potential pathologies that compress or otherwise affect structures passing through the orbital apex.

Presentation is according to the structures affected 1:

  • cranial nerves III, IV, and VI: ophthalmoplegia, proptosis, and ptosis
  • ophthalmic (V1) division of the trigeminal nerve: ipsilateral hypoesthesia of the forehead, upper eyelid, and cornea
  • optic nerve (II): visual deficit that can lead to blindness which is the major finding in differentiating between this syndrome and superior orbital fissure syndrome and cavernous sinus syndrome.

Prompt treatment is recommended to avoid serious complications, as optic nerve compression can result in optic nerve ischemia and atrophy, and subsequent vision loss. Treatment would be according to the etiology. For compressive disorders, decompressive surgery is usually needed 2.

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Cases and figures

  • Case 1: Graves ophthalmopathy
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  • Case 2: Tolosa-Hunt syndrome
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