In the orbit, the third, fourth, and fifth cranial nerves and the extraocular muscles themselves can be involved by a nonspecific inflammatory disease with pathology identical to that in Tolosa-Hunt syndrome. Such orbital disease, called orbital inflammatory pseudotumor when the collagenous tissues and fat are primarily involved and orbital myositis when the extraocular muscles are primarily involved, frequently involves both the orbit and the anterior cavernous sinus through the superior orbital fissure.y y The eye is painful and highly restricted in movement, usually in multiple directions. A condition with painful ophthalmoplegia reported as superior orbital fissure syndrome has no accompanying proptosis and has been most often ascribed to an inflammatory pachymeningitis from tuberculosis or syphilis, even when laboratory or pathological confirmation has been lacking. y Some cases have been thought to represent a sterile inflammatory reaction adjacent to infection in the paranasal sinuses. y
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