SUCCESSFUL MANAGEMENT OF RECURRENT ORBITAL INFLAMMATION WITH PAINFUL OPTHALMOPLEGIA CAUSED BY TOLOSA HUNT SYNDROME MULTIDISCIPLINARY APPROACH

Background: Orbital inflammatory disease (OID) is a diagnosis of exclusion, one of the differential diagnoses is Tolosa hunt syndrome. Even though corticosteroids are effective, this disease has the potential for recurrence.
Case Presentation: A 22-year-old male presented with left eye pain, proptosis, incomplete eyelid closure, decreased visual acuity, and limited eye movements, with symptoms recurring three times in one year. CT scan findings were consistent with Tolosa-Hunt Syndrome, and biopsy revealed a non-specific inflammatory process. Diagnosis was based on clinical presentation, surgical findings, and imaging. The patient was treated with high-dose corticosteroids and subsequently received immunomodulatory therapy to prevent recurrence, resulting in a symptom-free period over the past year.
Tolosa-Hunt syndrome is a rare condition caused by inflammation of the cavernous sinus, characterized by recurrent orbital pain and cranial nerve palsies involving nerves III, IV, V, and VI. In addition to clinical manifestations, imaging plays a critical role in
confirming the diagnosis. Corticosteroids are considered the first-line therapy for this condition. However, in this case, corticosteroid therapy alone failed to prevent recurrence. The administration of immunomodulatory agents such as methotrexate has been shown to effectively reduce the risk of relapse.
Conclusion: Tolosa-Hunt syndrome is an important differential diagnosis of orbital inflammatory disease, especially in recurrent cases with cranial nerve palsies. High-dose corticosteroids are the first-line treatment but have long-term side effects.
Immunomodulators like methotrexate may help prevent recurrence. This case highlights the need for a multidisciplinary approach and adequate patient education to achieve lasting remission.