Blinding ignorance: central retinal artery occlusion and orbital apex syndrome complicated with cavernous sinus thrombosis after tooth extraction

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SHAO YIN YEOH
Zhen Pang Chang, Dr
Anhar Hafiz Silim, Dr
Raja Norliza Raja Omar, Dr
Azida Juana Wan Ab Kadir, Dr

Abstract

Background: Central retinal artery occlusion accompanied with orbital apex syndrome
caused by odontogenic infection is very rare. Here we present a rare case of central retinal
artery occlusion and orbital apex syndrome complicated with cavernous sinus thrombosis
following tooth extraction.
Methods: case report
Results: A 62-year old undiagnosed diabetic Malay lady presented with sudden onset loss
of right eye vision. It was associated with right eye proptosis, ptosis and fever. The eyelid
was not swollen, red, warm or tender. Diagnosis of right central retinal artery occlusion
and orbital apex syndrome complicated with cavernous sinus thrombosis after tooth extraction and maxillary sinusitis was made based on computed tomography of brain and
orbit. She was started on broad spectrum intravenous antibiotics and antifungal. Right
Functional endoscopic sinus surgery (FESS) was done and showed a fungal ball on the
floor of the maxillary sinus. Despite treatment, she remained blind due to retinal ischemia
caused by central retinal artery occlusion.
Conclusion: A high index of suspicion is warranted to ensure accurate diagnosis so that
prompt treatment can be administered. In this case, imaging such as computed tomography scan aid in the diagnosis.
Conflicts of interest: The authors declare that there is no conflict of interests

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Section
Case Report

References

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