Abstract

Background Tolosa-Hunt Syndrome is a disease characterized by painful ophthalmoplegia caused by nonspecific inflammation of the cavernous sinus or superior orbital fissure. We presented a 65-year-old male with Tolosa-Hunt Syndrome. Case Presentation Mr. T 65 years old male complained double vision when seeing with both eyes since 3 weeks. Patient also felt pain around his left eye and left head. Visual acuity of both eyes were 5/6. Eye alignment shown left esotropia with ocular motility examination shows paresis of third, fourth and sixth left cranial nerves. Laboratory examination shown high HbA1C (7,5%), Total Cholesterol (212 mg/dL) and LDL (134mg/dL). Head MRI with contrast showed well defined lesion at intraconal apex to left optic canal and right optic canal which appears hyperintense on T1W1, T2W1 with compression on optic nerve axis and right left lateral rectus muscle. Patient received corticosteroid therapy with Methylprednisolone 32mg three times a day orally accompanied by Diabetes and Dyslipidemia therapy. Discussion Tolosa-Hunt syndrome is diagnosed through the clinical presentation, neuroimaging studies, and response to steroids. Within 4 weeks of corticosteroid therapy, patient complaints of unilateral pain has gone with orthophoria alignment and no resctriction in eye movement. Patient also felt double vision was significantly reduced. Conclusion Tolosa-Hunt syndrome is a painful ophthalmoplegia, usually unilateral, caused by nonspecific inflammation of the cavernous sinus with possible extension into the superior orbital fissure and orbital apex. With proper evaluation and management, corticosteroid therapy would give a satisfactory effect.