PMC8077525_01
Mild proptosis, right palpebral ptosis, fixed right mydriasis, and complete ophthalmoplegia.
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F1
V1 and V2 right territory, and loss of right nasolabial fold (shown in Fig. 1). Visual acuity assessment revealed a highly asymmetrical reduction of best-corrected visual acuity on the right (light perception - OD vs. 20/20 - OE).
Retinography showing retinal and choroidal ischemia.
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F2
Fundoscopy showed retinal and choroidal ischemia (shown in Fig. 2), confirmed by subsequent fluorescein angiography.
Face-CT, coronal view: Soft-tissue opacification of the right maxillary sinus extending to the ipsilateral ethmoidal cells. Bone remodeling of the orbit floor, with nodular infiltration of the adjacent extraconic space (white arrow).
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F3
The orbital and facial CT-scan showed filling of the right sphenoidal, ethmoidal, and maxillary sinus (compatible with pansinusitis) with ipsilateral extraconical extension (shown in Fig. 3).
Brain MRI, axial T1 with gadolinium. Diffuse infectious process of the orbit, infiltrating the fat, muscles, globe coats, lacrimal sac, and duct. Posterior extension to the cavernous sinus (white arrow) and along the dura mater of the ipsilateral anterior temporal lobe (black arrow).
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F4
The patient remained afebrile for 15 days, later developing rhinorrhea, evidencing the progression of the right orbital infection (shown in Fig. 4).