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The orbital apex is a complex region which serves as a craniofacial junction and acts as a conduit for numerous neural and vascular structures. A variety of infection, neoplastic, and inflammatory etiologies can affect this region, and often present with a consolation of neurovascular symptoms. In this article we present an unusual case of a polymicrobial sphenoethmoid sinusitis with extension into the orbital apex that presented as isolated vision loss.