A Meta-Analysis of Traumatic Orbital Apex Syndrome and the Effectiveness of Surgical and Clinical Treatments

Abstract

Purpose: Traumatic orbital apex syndrome (TOAS) commonly occurs secondary to trauma and irreversible ischemic optic neuropathy occurs as early as 2 hours after injury. Multiple treatment options have been described, however, there is a lack of consensus regarding the optimal treatment of these patients. Methods: A systematic review of the PubMed Database from 1970 to 2020 was conducted, using the search terms ''orbital apex,'' ''syndrome,'' and ''traumatic'' with the Boolean operators ''AND'' or ''OR.'' Papers that did not describe TOAS, describe patient outcomes or treatments, and those without available full English text were excluded. Patients were clustered and compared based on treatment received with the primary outcomes of improvement in vision or ophthalmoplegia. Results: Three hundred forty-seven papers were identified, of which 22 were included, representing 117 patients with TOAS. A total of 75.9% patients underwent decompressive surgery, 82.6% received steroids, and 72.2% received nerve growth factors. Fewer than 20% of patients were treated with antibiotics, diuretics, hormones, or hyperbaric oxygen. Overall, 51.7% of patients experienced improvement in vision and 85.2% in ophthalmoplegia at 6 months. Patients treated with surgical decompression (66.7% versus 16.7%, P < 0.01) or steroids (60.0% versus 0%; P < 0.01) were more likely to have improvement in vision than those without treatment. Nerve growth factors did not improve vision. Ophthalmoplegia did not improve with any treatment. Conclusions: Outcomes of TOAS tend to be poor, with overall low recovery of vision, though surgical decompression or steroid treatment did suggest improved visual outcomes. Further standardized patient data is needed to elucidate the comparative effectiveness of these interventions.

Orbital Apex Syndrome: A Case Series in a Tertiary Medical Center in Southern Taiwan

“…More than half of our patients were legally blind, and only 28.6% experienced an improvement in visual acuity after treatment. A meta-analysis of traumatic OAS also revealed poor overall visual prognosis, with only 51.7% of patients experiencing improvement in vision despite various medical and surgical interventions ( 20 ). The even worse visual outcome in our study may be related to different etiologies of OAS, as the disease in more than half of our cases was attributed to neoplastic causes.…”