245 CASE DESCRIPTION An 85-year-old male presented to the emergency room with a history of drooping of his left upper eyelid of 2 weeks of evolution. This was associated to severe left fronto-temporal pain. His past ocular history was notable for glaucoma and age-related macular degen- eration. On exam his best corrected visual acuity was 20/200 OD and 20/400 OS by Rosenbaum near chart. He had complete ptosis of his left eye with no levator function and complete ophthalmoplegia of the left eye with a negative forced duction test. His corneal sensation was intact. No proptosis was found. The left pupil was corectopic due to cataract surgery and measured 4 mm without reaction to light. No reverse relative afferent pupillary defect was noted. Both optics were pale with cup to disk ratio of 0.7 OD and 0.6 OS. A macular scar was present in the right eye, and there was geographic atrophy in the left eye. An MRI showed an expansile lesion in the left sphenoid sinus extending to the ethmoidal sinus and under- neath the sella to the medial wall of the cavernous sinus. There was no evidence of orbital involvement (Figure 1). Endoscopic biopsy of the lesion showed a cellular tumor composed of uniform small cells with round nuclei and scanty cytoplasm. There was an abundant fbrovascular stroma, separating the tumor cells in clusters. Immunohistochemical studies were positive for synaptophysin. These fndings were con- sistent with an olfactory neuroblastoma (Figure 2). Seminars in Ophthalmology, 24(6), 245–246, 2009 Copyright © 2009 Informa UK Ltd ISSN: 0882-0538 print/ 1744-5205 online DOI: 10.3109/08820530903388587 Esthesioneuroblastoma Presenting with Complete External Ophthalmoplegia Sheila M. García-Santana 1 , Julio A. Rodríguez 2 , Luis Serrano 2 , and Thomas R. Hedges III 3 1 University of Puerto Rico School of Medicine, San Juan, Puerto Rico 2 Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico 3 Department of Ophthalmology, Tufts University Medical Center, Boston, MA, USA ABSTRACT An 85-year-old male presented with unilateral third, fourth, and sixth cranial nerve palsies. Neuroimaging revealed a mass involving the medial wall of the left cavernous sinus, without orbital involvement. Biopsy of the mass provided a pathologic diagnosis of esthesioneuroblastoma. KEYWORDS: esthesioneuroblastoma, cavernous sinus, ophthalmoplegia, ptosis Correspondence: Julio A. Rodríguez, Department of Ophthal- mology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico. E-mail: jarodz75@gmail.com FIGURE 1 Magnetic resonance imaging, coronal view. Lesion in the left sphenoid sinus that extended to the ethmoid sinus, and underneath the sella to the medial wall of the cavernous sinus. There was no evidence of orbital involvement.