International Journal of Ophthalmology & Visual Science 2017; 2(2): 55-58 http://www.sciencepublishinggroup.com/j/ijovs doi: 10.11648/j.ijovs.20170202.13 Sino-Orbital Cellulitis Due to HSV Type I Selin Yetkinel 1 , Semai Bek 2 1 Agri State Hospital, Department of Neurology, Agri, Turkey 2 Baskent University Faculty of Medicine, Department of Neurology, Adana Teaching and Medical Research Center, Adana, Turkey Email address: selinyetkinel@gmail.com (S. Yetkinel), semaibek@yahoo.com (S. Bek) To cite this article: Selin Yetkinel. Semai Bek. Sino-Orbital Cellulitis Due to HSV Type I. International Journal of Ophthalmology & Visual Science. Vol. 2, No. 2, 2017, pp. 55-58. doi: 10.11648/j.ijovs.20170202.13 Received: January 24, 2017; Accepted: April 12, 2017; Published: May 17, 2017 Abstract: Orbital pseudotumor, is a heterogeneous group of disorders characterised by orbital inflammation and is a rare clinical entity and a diagnosis of exclusion. We report two cases with typical clinical manifestation and magnetic resonance images, but unresponsive to corticosteroid treatment which turned out to be caused by herpes simplex virus type I. Viral etiology must be carefully evaluated, especially in steroid unresponsive recurrent cases presumed to be pseudotumor orbita. Keywords: Orbital Cellulitis, Pseudotumor Orbita, Herpes Simplex Virus, Painful Ophthalmoplegia 1. Introduction Painful ophthalmoplegia is a common clinical presentation for all neurologists and ophthalmologists. There is a long list of differential diagnosis, including vascular, infective, rheumatologic causes and ophthalmologic migraine [1]. Despite improvements in laboratory and scanning techniques, most cases interpreted idiopathic. Extraocular orbital and adnexal inflammation with no identifiable local or systemic cause is often referred to as orbital pseudotumor. It remains a diagnosis of exclusion and is characterized by its chronicity, anatomic location, or histologic subtype. Corticosteroids are the mainstay of treatment inducing a rapid and dramatic reversal of inflammatory findings. Their mechanism of action is attributable to both anti-inflammatory and immunosuppressive properties. Despite the excellent and rapid response to corticosteroids, failures reported and unusual etiologic causes should be interpreted recurrent steroid unresponsive cases [2]. In this paper we present two cases of sino-orbital cellulites presumed to be orbital pseudotumor, unresponsive to corticosteroid treatment, due to herpes simplex virus type I. 2. Case Report Case 1: A 67-year-old male admitted to our department with major complaints of orbito-frontal pain, ptosis and vision loss on the left side. His complaints began 25 days before admission with diplopia and blurred vision and got worse gradually. As left sided ptosis and vision loss occurred two days ago, he decided to seek medical assistance. Type II diabetes mellitus was under control with oral antidiabetics for 8 years. His neurological examination revealed complete loss of function in the left II-III-IV and VI cranial nerves. Initial Snellen visual acuity was light perception and relative afferent papillary defect was detected in the affected eye. Retinal examination did not reveal diabetic retinopathy. The examination of the fellow eye was fully normal. Figure 1. Total ophthalmoplegia on the left side (Case 2). Case 2: A 51-year-old male admitted to our department with the complaints of orbito-frontal pain, diplopia and ptosis on the left side lasting for three days. His medical history