A 48-year-old male patient complains of diplopia (double vision). On neurologic examination he is unable to adduct his left eye and lacks a corneal reflex on the left side. Where is the most likely location of the lesion resulting in the symptoms?
The superior orbital fissure is the opening that allows the passage of the oculomotor nerve and the trochlear nerve; the lacrimal, frontal, and nasociliary branches of ophthalmic division of the trigeminal nerve; the abducens nerve; the superior and inferior divisions of the ophthalmic vein; and the sympathetic fibers from the cavernous plexus. The sensory and motor components of the corneal reflex are the ophthalmic division of the trigeminal nerve and the oculomotor nerve, whereas the eye impairment is due to a lesion to the oculomotor nerve, all of which are transmitted through the superior orbital fissure. The inferior orbital fissure contains the maxillary nerve, infraorbital vessels, and branches of the sphenopalatine (pterygopalatine) ganglion. The optic canal contains the ophthalmic artery and optic nerve, in addition to sympathetic fibers. The foramen rotundum contains the maxillary nerve. The foramen ovale contains the lesser petrosal nerve, the mandibular division of the trigeminal nerve, the accessory middle meningeal artery, and the emissary veins.
Inferior orbital fissure
Optic canal
Superior orbital fissure
Foramen rotundum
Head & Neck