Unilateral orbital pain, ptosis and binocular diplopia in three patients: case reports and review

Abstract

This report aimed to evaluate the clinical presentation, diagnosis and management of 3 Chinese patients with Tolosa-Hunt syndrome by reviewing a non-comparative, retrospective case series. Three patients (age range, 31- 60 years) with Tolosa-Hunt syndrome seen at Caritas Medical Centre, Hong Kong from January 2012 to May 2014 are reported. They presented with symptoms of unilateral orbital pain, ptosis and binocular diplopia, and subsequently developed various presentations including facial hypoesthesia, facial weakness, proptosis, and pupil-involving third, fourth, fifth, sixth or seventh nerve palsies. All patients responded to systemic steroid therapy while one developed relapse when oral steroid therapy was tapered. Tolosa-Hunt syndrome is a rare clinical condition in Chinese with various presentations. Clinical suspicion with comprehensive patient evaluation is essential to establish the correct diagnosis. Treatment should be individualized and tapered according to clinical response.