Ophthalmoplegia considered to be Tolosa-Hunt syndrome: A case report

Tolosa-Hunt syndrome (THS) is a type of painful ophthalmoplegia characterized by unilateral orbital pain and oculomotor paresis. This report describes a case of painful ophthalmoplegia considered to be THS. The patient was a 72-year-old woman. After dental implant placement in the left maxillary first molar site, she was referred to our hospital for persistent left periorbital and facial pain, diplopia, and taste disorder. With an initial diagnosis of trigeminal neuralgia, diplopia, and taste disorder, we began administration of carbamazepine and polaprezinc, and asked the department of ophthalmology in our hospital to examine her diplopia. With the increase in serum zinc levels, the taste disorder resolved, but her periorbital pain and diplopia were aggravated, and she had to be hospitalized. As a result of extensive examinations, we suspected her painful ophthalmoplegia was due to cavernous sinus abnormalities; finally, THS was diagnosed. There was significant improvement in the periorbital pain within 48 h after the start of corticosteroid therapy. Since then, she has never suffered from painful ophthalmoplegia. This case indicates that careful evaluation and accurate diagnosis are critical in cases of painful ophthalmoplegia, and the possibility of THS should always be kept in mind.