TABLE 1

Causes of orbital apex syndrome

Inflammatory
Sarcoidosis, systemic lupus erythematosus, antineutrophil cytoplasmic antibody vasculitis (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis), Tolosa-Hunt syndrome, giant cell arteritis, orbital inflammatory pseudotumor, thyroid orbitopathy, immunoglobulin G4-related disease
Infectious
Fungi: Aspergillosis, mucormycosis
Bacteria: Streptococcus species, Staphylococcus species, Actinomyces species, gram-negative bacilli, anaerobes, Mycobacterium tuberculosis
Spirochetes: Treponema pallidum
Viruses: Herpes zoster ophthalmicus
Neoplastic
Head and neck tumors: nasopharyngeal carcinoma, adenoid cystic carcinoma, squamous cell carcinoma
Neural tumors: neurofibroma, meningioma, ciliary neurinoma, schwannoma
Metastases: lung, breast, renal cell, malignant melanoma
Hematologic: non-Hodgkin lymphoma, leukemia
Perineural invasion of cutaneous malignancy
Iatrogenic
Sinonasal surgery, orbital-facial surgery
Traumatic
Orbital apex fracture, retained foreign body, penetrating or nonpenetrating injury
Vascular
Carotid cavernous aneurysm, carotid cavernous fistula, cavernous sinus thrombosis, sickle cell anemia
Other
Mucocele
  • Adapted from reference 8.