Tolosa-Hunt Syndrome in a Young Subject

Abstract

Tolosa-Hunt syndrome (THS) is a non-specific inflammation of the cavernous sinus or superior orbital fissure which causes painful, usually unilateral ophthalmoparesis or ophthalmoplegia. A 22-year-old lady presented with diminution of vision, pain in her right eye (OD) accompanied-with protrusion of the right eyeball and drooping of right upper eyelid. There was no other significant history or any other systemic complaint. Best corrected visual acuity (BCVA), color vision, contrast sensitivity, slit lamp examination, indirect ophthalmoscopy, Hertel’s exophthalmometry, worth four dot test, strabismus evaluation using prism bars, forced duction test, visual field charting, ultrasound B- scan, contrast-enhanced computed tomography of the head and orbit, and hematological investigations were performed. A decrease in the visual acuity, corneal sensations, contrast sensitivity in the affected eye was observed. Proptosis, severe ptosis, exotropia with right hypotropia and limitation of ocular movements was seen OD. Crossed diplopia was present and visual field charting demonstrated a right hemi-field defect. Erythrocyte sedimentation rate (ESR) was raised. All routine and other blood tests were normal. A high dose of oral systemic steroids led to dramatic improvement and amelioration of pain with restoration of BCVA, contrast sensitivity, ocular motility, ptosis, strabismus and diplopia. Tolosa Hunt Syndrome (THS) is a rare observation in a young patient. It is a diagnosis of exclusion and other systemic associations must be ruled out. A dramatic improvement is seen in the symptoms of pain, ophthalmoplegia, visual loss, ptosis, strabismus and diplopia after starting high dose systemic steroids.

Keywords

• tolosa- hunt syndrome
• visual fields
• young age
• corticosteroids
• proptosis
• ptosis
• painful ophthalmoplegia