Abstract
A patient presents to the emergency room with two weeks of complete ptosis of the right eye. His past medical history is significant for a remote stroke, well-controlled diabetes, coronary artery disease, basal cell carcinoma of the ear, and squamous cell carcinoma of the right forehead with perineural invasion to the supraorbital nerve, for which Mohs surgery and radiation therapy was recently completed. On further discussion, it is revealed that over the past several months, the patient has had episodic periorbital pain, partial ptosis, and cranial nerve deficits. Prior imaging over this time course has revealed perineuritis only, and the patient had been diagnosed with a cranial nerve VI palsy, cranial III palsy, and optic perineuritis by various physicians. On presentation, examination reveals complete ptosis with a levator function of 0mm. Overall, this case demonstrates a unique case of cutaneous squamous cell carcinoma with perineural spread causing cavernous sinus syndrome.
Presentation Date: 01/22/2026
Issue Date: 01/30/2026
