The clinical features and outcomes of Tolosa-Hunt syndrome

BMC Ophthalmol. 2021 May 27;21(1):237. doi: 10.1186/s12886-021-02007-0.


Background: The objective of this study was to investigate the clinical features and outcomes of Tolosa-Hunt syndrome (THS).

Methods: A retrospective review of the medical records was performed on patients with THS between March 2016 and January 2020. A total of eleven patients fulfilling the International Classification of Headache Disorders (ICHD-3 beta) diagnostic criteria for THS were included in this study.

Results: The average age of the patients with THS was 57.18 ± 15.32 years and the mean duration of recovery was 26.91 ± 24.35 days. All eleven patients had orbital or periorbital pain as the first symptom followed by diplopia. Ptosis was found in five patients (45.45 %) in the involved eye. Sixth cranial nerve (CN) palsy was most common (eight cases, 72.73 %), followed by third and fourth CN palsy (five cases, 45.45 %, respectively), optic neuritis (two cases, 18.18 %), and trigeminal nerve and facial nerve palsy (one case, 9.09 %, respectively). One patient with optic neuritis failed to recover visual acuity and the other ten patients completely recovered their ocular motor limitation. All patients were initially treated with steroids. One patient relapsed after five weeks and one patient had a history of THS five years earlier.

Conclusions: THS responded well to steroid treatment, but if it was accompanied by optic neuritis as optic nerve involvement, we suggest follow-up with high dose steroid treatment especially was important.

Keywords: Tolosa-Hunt syndrome; optic nerve; orbital pain; painful ophthalmoplegia; paralysis.

MeSH terms

  • Adult
  • Aged
  • Diplopia
  • Headache
  • Humans
  • Magnetic Resonance Imaging
  • Middle Aged
  • Ophthalmoplegia*
  • Retrospective Studies
  • Tolosa-Hunt Syndrome* / diagnosis
  • Tolosa-Hunt Syndrome* / epidemiology