Progressive visual loss and motility deficit.

A 63-year-old female with known stage III, low grade non-Hodgkin's lymphoma presented with progressive visual loss in the left eye and binocular diplopia in all positions of gaze. The left globe was almost immotile. Two MRI's of the orbit were interpreted as normal. Lumbar puncture did not reveal abnormal cytology. Although orbital apex involvement is uncommon in non-Hodgkin's lymphoma, the patient's clinical findings clearly indicated a lesion in this area, which was confirmed by a third MRI. Review of one of the initial films showed evidence of orbital apex involvement. To prevent diagnostic delay and unnecessary repeat imaging, the clinical diagnosis of orbital apex syndrome should be clearly communicated to the radiologist. Prompt recognition of orbital apex syndrome may improve visual outcome.