Exploring 'No Man's Land'
An Overview Of Orbital Apex / Superior orbital fissure / Cavernous Sinus Lesions

Ambika Selvakumar

Aim: The region of the orbital apex, superior orbital fissure and adjacent cavernous sinus poses unique challenges in the diagnosis and management of pathology in these areas. The fields of ophthalmology, neurology, and otorhinolaryngology literally overlap at this "no man's land" necessitating a coordinated management. Our aim is to appreciate the - differences between these overlapping , yet different clinical disorders and to discuss the challenges and select the most appropriate imaging modality to asses these conditions .

Abstract: Orbital apex syndrome (OAS) is an association of lesions of the third, fourth, sixth, and ophthalmic division of the fifth cranial nerve (V1), with optic neuropathy. Superior orbital fissure syndrome (SOFS) and cavernous sinus syndrome (CSS) produce similar clinical pictures like OAS with absence of optic neuropathy , with added involvement of the maxillary branch of the Trigeminal nerve (V2) and oculosympathetic fibers . In spite of their anatomical proximity , the clinical features and management of these conditions can differ based on their etiology and presentation. Most of these conditions can be the initial manifestation of an occult malignancy or an undiagnosed infectious disease.

Conclusion: The ophthalmologists may be the first clinician to see patients with disorders of the "no man's land".A systematic clinical approach with the best suited imaging modality will yield success in the diagnosis and management of conditions affecting "the no man's land".