A 39 years old woman presented with painful loss of vision in left eye for 3 days. Patient had similar complaints in left eye 3 months back. On examination, her visual acuity was perception of light with accurate projection of rays with RAPD. Severe ptosis was present in left eye. The patient had restricted extra ocular movement in all gazes and numbness in periorbital region. Right eye examination was unremarkable. The case was diagnosed as multiple cranial nerve palsy and MRI contrast revealed abscess in the left orbital apex region involving, left cavernous sinus, extra axial left temporal lobe, extending into superior orbital fissure and associated patchy meningeal involvement. Tolosa-Hunt syndrome (THS) is a rare disorder characterized by severe unilateral headaches with multiple cranial nerve palsies, usually involving the third, fourth, fifth, and sixth cranial nerves and periorbital pain, along with weakness and paralysis of extra ocular muscles. [1] The exact cause of THS is not known, but the disorder is associated with inflammation of cavernous sinus and superior orbital fissure.

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