Ophthalmic manifestations of paranasal sinus mucocoeles

The Clinical Course of Paranasal Sinus Mucocoeles-A Retrospective Case Series

Paranasal sinus mucocoeles can be secondary to chronic rhinosinusitis and can result in intra-orbital and intra-cranial complications requiring surgical management. The natural history of conservatively managed mucocoeles is not well established. We aimed to quantify the proportion of radiologically identified paranasal sinus mucocoeles resulting in complications over 10 years. We retrospectively reviewed anonymised data on radiologically diagnosed mucocoeles between 2011 and 2021 at two UK hospitals. We collected data on age at presentation, extent of sinus involvement, management and complications. We identified 60 patients with mucocoeles, of which 35 (58%) were incidental findings from radiological investigations. The mean age was 58 years. Fifteen patients (25%) were managed surgically and one presented with recurrence following surgery. Overall, six patients (10%) had an intra-orbital extension of their mucocoele and three (5%) had an intra-cranial extension. There was no difference in the rates of intra-cranial extension between conservative and surgical cases but surgical cases included a higher rate of intra-orbital extensions (27% vs. 4%, p = 0.01). The proportion of patients requiring surgical intervention in this study is low. Incidental and asymptomatic mucocoeles have a relatively benign disease course and selected uncomplicated cases can be considered for conservative management with serial scanning at 12 months.

A Fronto-ethmoidal Sinus Mucocele presenting with optic disc edema

The frontal and anterior ethmoidal sinus mucoceles may enlarge progressively and invade into the orbit by destructing the bony walls of the sinuses leading to diplopia or proptosis, but it rarely result in optic nerve impairment. We report on a case of fronto-ethmoidal sinus mucoceles presenting with unilateral optic disc edema without visual disturbances. Ocular manifestations, radiographic techniques, and histopathological evaluation were used to make the diagnosis. Early diagnosis through a combination of ophthalmological examinations and radiographic techniques is imperative in patients with fronto-ethmoidal sinus mucoceles presenting with optic disc edema. It is important for the ophthalmologist to be aware of the ocular manifestations associated with sinus mucoceles to avoid misdiagnosis.

The Clinical and Radiologic Features Affecting the Ocular Symptoms in Patients With Paranasal Sinus Mucoceles Involving the Orbit

INTRODUCTION

Paranasal sinus (PNS) mucoceles may involve orbit and have ophthalmic manifestations. The objective of this study was to investigate the clinical and radiological features affecting the ophthalmic manifestations in patients with PNS mucoceles involving the orbit.

METHODS

Fifty-two patients underwent endoscopic sinus surgery for PNS mucoceles with orbital involvement were investigated. Ophthalmic manifestations included exophthalmos, ocular pain, diplopia, visual disturbance. The correlation between ocular symptoms and the mucocele volume, origin site of mucocele, and the involvement of extraocular muscles or optic nerve were evaluated.

RESULTS

Ophthalmic manifestations were significantly higher in the anterior ethmoid and frontal sinus involvement. Exophthalmos was significantly increased in the involvement of anterior ethmoid sinus, frontal sinus, and superior group ocular muscles, but decreased in the mucocele of maxillary sinus. Ocular pain was significantly lower in the involvement of anterior ethmoid sinus, frontal sinus, and superior group ocular muscle. Diplopia showed no significant differences among clinical and radiological parameters. Visual disturbance was significantly higher in the involvement of posterior ethmoid sinus and sphenoid sinus. The volume of mucocele, relation to optic nerve, adjacent bony change, and duration of ocular symptom had no significant effect on ocular symptoms in patients with PNS mucoceles involving the orbit.

CONCLUSION

The volume of mucocele did not affect the ophthalmic manifestations in patients with PNS mucoceles involving the orbit. Exophthalmos, ocular pain, and visual disturbance were significantly correlated with the involved sinus of PNS mucoceles.

Punctal agenesis and delayed-onset dacryocystocele in CHARGE syndrome

Punctal agenesis and other nasolacrimal abnormalities have been infrequently reported in CHARGE syndrome-a constellation of findings affecting the eyes, heart, choana, and ears-which generally presents at birth. We present a rare case of punctal agenesis with delayed-onset dacryocystocele/lacrimal sac mucocele in a teenager with CHARGE syndrome.

Orbital apex disorders: Imaging findings and management

Orbital apex disorders include orbital apex syndrome, superior orbital fissure syndrome and cavernous sinus syndrome. These disorders result from various etiologies, including trauma, neoplastic, developmental, infectious, inflammatory as well as vascular causes. In the past, these have been described separately based on anatomical locations of disease process; however, these three disorders share similar causes, diagnostic evaluation and management strategies. The etiology is diverse and management is directed to the causative process. This imaging review summarizes the pertinent anatomy of the orbital apex and illustrates representative pathological processes that may affect this region. The purpose of this review is to provide an update on the current status of diagnostic imaging and management of patients with orbital apex disorders.

Endoscopic Management of Paranasal Sinus Mucoceles: Meta-analysis of Visual Outcomes

Objective Paranasal sinus mucoceles are benign cystic lesions originating from sinus mucosa that can impinge on adjacent orbital structures, causing ophthalmic sequelae such as decreased visual acuity. Definitive treatment requires surgery. We present the first meta-analysis quantifying the effect of preoperative visual function and time to surgery on postoperative visual acuity outcomes. Data Sources PubMed, Ovid, Embase, Web of Science, and the Cochrane Library. Methods Two independent authors systematically reviewed articles describing outcomes after endoscopic sinus surgery for paranasal sinus mucoceles presenting with visual loss. Available data from case reports and series were combined to analyze the associations among preoperative visual acuity, time to surgery, and postoperative outcomes. Results Eighty-five studies were included that provided data on 207 patients. The average presenting visual acuity was 1.57 logMAR (logarithm of the minimum angle of resolution), and the average postoperative visual acuity was 0.21 logMAR, with visual improvement in 71.5% of cases. Preoperative visual acuity ≥1.52 logMAR correlated with postoperative improvement >1 logMAR ( R = 0.4887, P < .0001). A correlation was found between a time to surgery <6 days and postoperative improvement ( R = 0.297, P < .0001). Receiver operator curve analysis of these thresholds demonstrated a moderately accurate prognostic ability (area under the curve: 75.1 for preoperative visual acuity and 73.1 for time to surgery). Conclusion Visual loss resulting from paranasal sinus mucoceles is potentially reversible in most cases, even those presenting with poor vision. When possible, surgery should be performed promptly after diagnosis, but emergency surgery does not appear to be necessary for vision restoration.

Predictive factors for vision recovery after optic nerve decompression for chronic compressive neuropathy: systematic review and meta-analysis

Objectives Surgical optic nerve decompression for chronic compressive neuropathy results in variable success of vision improvement. We sought to determine the effects of various factors using meta-analysis of available literature. Design Systematic review of MEDLINE databases for the period 1990 to 2010. Setting Academic research center. Participants Studies reporting patients with vision loss from chronic compressive neuropathy undergoing surgery. Main outcome measures Vision outcome reported by each study. Odds ratios (ORs) and 95% confidence intervals (CIs) for predictor variables were calculated. Overall odds ratios were then calculated for each factor, adjusting for inter study heterogeneity. Results Seventy-six studies were identified. Factors with a significant odds of improvement were: less severe vision loss (OR 2.31[95% CI = 1.76 to 3.04]), no disc atrophy (OR 2.60 [95% CI = 1.17 to 5.81]), smaller size (OR 1.82 [95% CI = 1.22 to 2.73]), primary tumor resection (not recurrent) (OR 3.08 [95% CI = 1.84 to 5.14]), no cavernous sinus extension (OR 1.88 [95% CI = 1.03 to 3.43]), soft consistency (OR 4.91 [95% CI = 2.27 to 10.63]), presence of arachnoid plane (OR 5.60 [95% CI = 2.08 to 15.07]), and more extensive resection (OR 0.61 [95% CI = 0.4 to 0.93]). Conclusions Ophthalmologic factors and factors directly related to the lesion are most important in determining vision outcome. The decision to perform optic nerve decompression for vision loss should be made based on careful examination of the patient and realistic discussion regarding the probability of improvement.

Frontal sinus mucoceles presenting in the upper eyelid: an easily missed diagnosis

Frontal sinus mucoceles are epithelium-lined mucus-containing sacs that are capable of bony expansion causing a spectrum of ophthalmological symptoms. If left untreated, they can erode the thin sinus wall causing life-threatening complications such as meningitis. We would like to alert the clinicians to this diagnosis that can be easily misdiagnosed. The first patient appeared to have an allergic blepharo-conjunctivitis that was not responding to topical and systemic medications. The second patient presented with recurrent preseptal cellulitis unresponsive to oral antibiotics. CT imaging of both patients revealed frontal sinus mucoceles. Both patients recovered well with sinus surgery. Management of these patients needed a close liaison with our ENT and radiology colleagues to warrant a good outcome.

Paranasal sinus mucoceles with ophthalmologic manifestations: a 17-year review of 96 cases

BACKGROUND

The purpose of this study was to assess the characteristics of paranasal sinus mucoceles with ophthalmologic manifestations with a focus on optic neuropathy.

METHODS

From January 1993 to May 2010, 96 consecutive patients diagnosed with paranasal sinus mucoceles with ophthalmologic manifestations were investigated. Clinical and therapeutic factors and demographics were reviewed from medical records. Statistical associations between clinical and therapeutic factors and visual outcomes after surgery were also analyzed.

RESULTS

A total of 352 patients were diagnosed with paranasal sinus mucoceles and underwent surgical treatment. Ninety-six of them presented with ophthalmologic symptoms, and periorbital swelling and pain were the most common symptoms (36.4%) in those patients. Among the 96 patients with ophthalmologic manifestations, 18 (18.8%) were diagnosed with optic neuropathy based on the deterioration of their visual acuity and unilateral relative afferent papillary defect. Ten of these 18 patients showed improvements in their vision after surgical intervention. The statistical analysis of the association between clinical and therapeutic factors and visual outcomes showed that the presence of infection was the only significant factor (p = 0.023).

CONCLUSION

Paranasal sinus mucoceles present various ophthalmologic manifestations. Among them, optic neuropathy may be one of the most devastating conditions. In treating optic neuropathy caused by mucoceles, the presence of infection was the only factor that had any influence on postoperative visual outcomes. Therefore, we conclude that not only surgical drainage and ventilation of the sinus are necessary, but infection control is also a vital factor in treating mucoceles with optic neuropathy.