A 64-year old male presented to our institution with painful ophthalmoplegia. The initial differential diagnosis included orbital apex disorders, such as orbital apex syndrome (OAS), cavernous sinus thrombosis (CST), and superior orbital fissure syndrome (SOFS). Ultimately, the diagnosis was acute invasive fungal rhinosinusitis (AIFRS) secondary to an odontogenic infection from carious teeth in the maxilla. Significant overlap exists between AIFRS and orbital apex disorders, making it prudent to include AIFRS in the differential diagnosis for painful ophthalmoplegia. The purpose of this review is to detail this specific patient's presentation and hospital course along with a brief review of AIFRS and orbital apex disorders with their distinguishing features.

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