Silent Sinus Syndrome
By Samuel Baharestani, MD, Cincinnati Eye Institute, and Jonathan Pargament, MD, University of Cincinnati, and photographed by Jeffrey A. Nerad, MD, Cincinnati Eye Institute
A 29-year-old woman was referred by her neurologist to our clinic because of a change in the appearance of her left eyelid, corresponding to dull, left-sided headaches, which had been present for eight months. She was in the second trimester of her first pregnancy and was anemic but had no other systemic medical problems. The patient had not noticed any changes in vision but reported having soreness with left gaze. Her past ocular history was significant only for LASIK surgery five years prior to presentation.
On examination, her uncorrected visual acuity was 20/20 in both eyes. Ocular motility and confrontation visual fields were full bilaterally. There was no palpable step-off of the bony orbital rims. A superior sulcus deformity with 4 mm of enophthalmos was present on the left side.
A CT scan of the orbits and sinuses was performed; they revealed inferior bowing of the orbital floor, with multiple circular air-fluid levels in the left maxillary sinus. A diagnosis of silent sinus syndrome was made, for which the patient was referred to the otolaryngology service for functional endoscopic surgery to decompress and evacuate her opacified maxillary sinus.
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