MRCP PACES Multiple Cranial Neuropathies Orbital Apex Syndrome
  • Syndrome involving damage to the following nerves
    • Optic nerve (II)
    • Oculomotor nerve (III)
    • Trochlear nerve (IV)
    • Ophthalmic division of the trigeminal nerve (V1)
    • Abducens nerve (VI)
  • To test for optic nerve dysfunction:
    • Reduced visual acuity
    • Red desaturation
    • Afferent pupillary defect
    • Relative afferent pupillary defect
    • Offer
      • Colour vision testing
      • Formal perimetry assessment
      • Fundoscopy (optic atrophy)
  • Causes
    • Inflammatory
      • Sarcoidosis
      • Systemic lupus erythematosus
      • Churg-Strauss syndrome
      • Wegner’s granulomatosis
      • Giant cell arteritis
      • Orbital inflammatory pseudotumour
      • Thyroid orbitopathy
    • Infectious
      • Per-orbital cellulitis
      • Herpes zoster
      • Syphilis
      • Bacterial meningitis
    • Neoplastic
      • Nasopharyngeal carcinoma
      • Lymphoma
      • Nerve sheath tumours
        • Neurofibroma
        • Meningioma
        • Schwannoma
    • Traumatic
      • Orbital apex fracture
      • Penetrating injury
  • For orbital apex syndrome, consider MRI of the orbits with contrast and fat suppression sequences
  • Thyroid function tests are critical in evaluation of orbital apex syndrome
  • Consider autoimmune work-up if history suggestive
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