Gradenigo Syndrome: A Clinical Overview

Gradenigo syndrome is a rare but important complication of otitis media. It is classically described as a triad of persistent ear infection, abducens nerve (cranial nerve VI) palsy, and retro-orbital or facial pain along the trigeminal nerve (cranial nerve V) distribution. From an ophthalmologist’s perspective, the lateral rectus weakness and resulting diplopia are often the first symptoms that prompt referral. The syndrome arises when infection spreads to the petrous apex of the temporal bone, leading to osteomyelitis and subsequent cranial nerve dysfunction.