Sinus Disease Affecting the Orbit
Tumors from the nose or the paranasal sinuses may secondarily invade the orbit. Proptosis and globe displacement are common. The diagnosis is made by imaging, which is ordered to include the base of the sinuses for proper evaluation.
Mucoceles and mucopyoceles of the sinuses (Fig 5-22) are cystic structures with pseudostratified ciliated columnar (respiratory) epithelium resulting from obstruction of the sinus excretory ducts. These lesions may invade the orbit by expansion and erosion of the bones of the orbital walls and cause globe displacement. In the case of mucoceles, the cysts are usually filled with thick mucoid secretions; in the case of mucopyoceles, they are filled with pus. Most mucoceles arise from the frontal and/or ethmoid sinuses. Surgical treatment includes evacuation of the mucocele and reestablishment of drainage of the affected sinus or obliteration of the sinus by mucosal stripping and packing with bone or fat.
Silent sinus syndrome is another orbital condition that results from sinus outflow pathology (Fig 5-23). Chronic subclinical sinusitis presumably causes thinning of the bones of the maxillary sinus, leading to collapse of the orbital floor and subsequent enophthalmos. This collapse may occur in association with a recent significant change in atmospheric pressure (eg, during airplane travel or scuba diving). Upper eyelid ptosis, deepening of the superior sulcus, and, occasionally, diplopia may occur. Treatment includes restoration of maxillary sinus aeration and reconstruction of the orbital floor. The entrapped maxillary sinus secretions are often sterile in nature.
Squamous cell carcinoma and adenocarcinoma of the sinuses may secondarily invade the orbit (Fig 5-24). These malignancies usually arise in the maxillary sinuses, followed by the nasopharynx or the oropharynx. Nasal obstruction, epistaxis, or epiphora may be associated with the growth of such tumors. Treatment is usually a combination of surgical excision and radiation therapy and often includes exenteration if the periorbita is traversed by tumor.
Nonepithelial tumors that can invade the orbit from the sinuses, nose, and facial bones include a wide variety of benign and malignant lesions. Among the most common are osteomas, fibrous dysplasia, and miscellaneous sarcomas.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.