A case of orbital apex syndrome in a patient with malignant otitis externa

A rare case of skull base infection with a rapid clinical course leading to visual loss and eventually death in a poorly-controlled diabetic patient is presented. A 37- year-old woman presented with a history of visual loss and painful protrusion of the right eye for the preceding 3 days. This was accompanied by vertigo and right-side facial weakness. The patient had perception of light in her right eye and 20/25 (presenting visual acuity) in the fellow eye, accompanied by right-side proptosis, total ophthalmoplegia, optic disc pallor and central retinal artery occlusion. Magnetic resonance imaging showed the presence of oedema with soft- tissue thickening in the right external auditory canal along with evidence of fluid within the middle ear cavity and mastoid air cells on the right side. A diagnosis of Orbital Apex Syndrome was made and treatment initiated.