Orbital Apex Syndrome Secondary to Middle Cranial Fossa Meningocele: A Rare Pediatric Case.

BACKGROUND

Orbital apex syndrome (OAS) is a rare, sight-threatening condition caused by injury or compression of neurovascular structures in the orbital apex, which, depending on the underlying etiology, may even pose a life-threatening risk. Prompt recognition and intervention are essential to prevent permanent visual loss and systemic complications.

CASE PRESENTATION: We report a 10-year-old child presenting with acute left-sided proptosis, eyelid edema, ophthalmoplegia, and optic disc edema, following a history of orbital cellulitis and meningitis in early childhood. Imaging revealed a middle cranial fossa meningocele (MEC) extending into the orbital apex, associated with sinusitis and purulent meningitis. Ophthalmic examination demonstrated severe restriction of left-eye movements, proptosis, and a relative afferent pupillary defect. A multidisciplinary team - including ophthalmology, neurology, ENT, and radiology - initiated urgent intravenous antibiotics, resulting in rapid systemic and ocular improvement. The patient subsequently underwent cranial osteoplasty to repair the skull base defect. At discharge and four-month follow-up, visual acuity was normal, extraocular movements had largely recovered, and imaging showed intact retinal nerve fiber layers.

CONCLUSION

This case underscores the importance of early recognition and collaborative management in OAS. Middle cranial fossa meningoceles, though rare, should be considered among potential structural causes of orbital apex compression.