Orbital apex syndrome in a child

A 8-year-old male presented with visual loss, diplopia, ptosis, pain behind the left eye, facial numbness and vomiting of one week duration. The ophthalmological, neurological and radiological examination showed a lesion of the left orbital apex with extension into the cavernous sinus. Examination of the nose and paranasal sinuses did not reveal any abnormality. Transnasal Endoscopic orbital decompression was performed and inflamed granulation tissue found in the orbital apex was removed. Microbiology showed fungal elements which on culture grew Aspergillosis flavus. Antifungal therapy with new generation oral drug (voriconazole) resulted in complete resolution of symptoms. Relevant literature is reviewed and discussed.