A prospective study of orbital manifestations of sinus disease

Abstract

Introduction: Anatomically, the orbital cavity has an intimate topographical relationship to the surrounding paranasal sinuses. Hence orbit may be involved in majority of expanding or bone eroding lesions originating in the sinuses and in the nasopharynx. The anatomical basis of ophthalmic complications in paranasal sinus disease is that the orbit is nearly completely surrounded by sinuses, except laterally; the separating bones are very thin, with numerous suture lines. Materials and Methods: Patients with paranasal sinus disease presenting to ENT OPD at Maheshwara Medical College and Hospital, Chitkul (V), Near Isnapur X Roads, Patancheru, Telangana from October 2019 to October 2020 were screened for orbital manifestations.ENT evaluation, Nasal endoscopy,CT PNS,Culture sensitivity,KOH smear, wherever necessary was undertaken.Out of these, fourteen patients with orbital disease were referred to Opthalmology department of Maheshwar Medical College and Hospital and were thoroughly evaluated. Patients with endocrine ophthalmopathy like thyroid ophthalmopathy were excluded. Extensive history was taken and general examination was done with the collaboration of other departments wherever necessary. Visual acuity was tested using Snellen’s chart, anterior segment was evaluated using slit lamp. Posterior segment was evaluated by direct / indirect ophthalmoscopy as appropriate. B-scan ultrasonography / CT scan / MRI were done wherever necessary. Appropriate specimens were sent for culture and sensitivity in suspected infectious conditions. Appropriate antibiotic / anti-fungal treatment was given according to standard protocols. In suspected tumours, complete surgical excision was done at ENT / Neurosurgery departments and specimens were sent for histopathological examination and the diagnosis was confirmedResults: Out of the 14 patients 4 were female and 10 were male. Age ranged from 16 years to 70 years. 5 had maxillary sinus disease (3 cases of Invasive Fungal Sinusitis / Mucormycosis and 2 cases of Squamous cell Carcinoma). Frontal sinus disease was seen in two patients, one fibrous dysplasia and one malignancy. Five patients had ethmoidal sinus disease of which three patients were found to have ethmoidal sinus tumour (Malignant melanoma, Squamous cell Carcinoma). More than two sinuses were involved in 2 patients.Conclusion: Early screening of patients with sinus disease by an Ophthalmologist can help in preventing severe vision threatening orbital complications.