Traumatic superior orbital fissure syndrome: Review of literature and report of three cases
A 26-year-old male suffered injury due to road traffic accident and reported to the maxillofacial unit after 5 days with the complaint of pain and tenderness over the left cheek region, inability to move the left eye, and numbness over the left forehead. On examination, there was mild swelling on the left half of the face with partial ptosis of the left eye. There was mild proptosis and periorbital edema but marked subconjunctival hemorrhage in left eye []. Pupil was dilated with vision intact and there was complete absence of movement of eyeball in all the gazes. On ophthalmic examination, there was loss of corneal reflex, loss of direct light reflex, presence of consensual reflex, and loss of accommodation reflex. An ophthalmologic consultation revealed normal fundoscopic findings. On palpation, there was tenderness at the left fronto-zygomatic suture and infraorbital rim. His mouth opening was normal. A computerized tomography (CT) scan showed proptosis of the left eye with no intraconal or extraconal hemorrhage. There was fracture of the lateral wall of the orbit with obvious bony impingement on the lateral rectus. The medial wall and the ethmoidal sinuses were uninvolved []. A diagnosis of fracture of left zygomatic bone with SOFS was made. The patient was managed with megadose steroid (loading with 30 mg/kg methylprednisolone followed by 15 mg/kg every 6 h for 3 days) and anti-inflammatory drugs. There was partial improvement in the ptosis, proptosis, and ophthalmoplegia after 2 weeks. At the end of 6 weeks, there was complete recovery of ptosis and ophthalmoplegia [].