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We present the case of a patient with a transethmoidal penetrating injury to the contralateral orbital apex and optic nerve. Orbital apex fractures can be broadly classified as linear (not displaced), comminuted (with fragment displacement), and apex avulsion.1 The neurovascular anatomy of the orbital apex is complex, and injuries involving this area, directly or indirectly, can have different clinical outcomes. Numerous syndromes have been described depending on the combination of clinical findings. Clinical symptoms and signs do not always correlate with the degree of trauma or radiological findings. The neurovascular structures could be severely traumatized without an orbital apex fracture being present.
Lubbe DE, Gardiner I, Fagan JJ. An Unusual Orbital Foreign Body Resulting in the Orbital Apex SyndromeReport of a Case. Arch Otolaryngol Head Neck Surg. 2005;131(6):526-528. doi:10.1001/archotol.131.6.526