Fronto-orbital mucocele and orbital involvement in occult obstructive frontal sinus disease. Issue 4 (14th August 2015)

• Record Type: Journal Article
• Authors: Tailor, Rajen; Obi, Ebube; Burns, Joyce; Sampath, Raghavan; Durrani, Omar M; Ford, Rebecca
• Is Part Of: British journal of ophthalmology. Volume 100:Issue 4(2016)
• Page Start: 525
• Page End: 530
• Publication Date: 2015-08-14
• Subjects: Anatomy -- Infection -- Orbit -- Treatment other; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2015-306940
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Aims: To describe the clinical features of orbital involvement arising from occult obstructive frontal sinus disease and to highlight key features to aid diagnosis. Methods: A retrospective review of the case notes of 15 patients who presented to three regional oculoplastics units over a 7-year period were reviewed. Patient demographics, clinical characteristics, relevant medical history, microbiology results, imaging, management and outcomes were assessed. Results: The mean age of our patients was 55 years. Pain was the presenting feature in 8 patients while 14 presented with upper lid swelling and redness. This swelling was medial in 60% and diffuse in 40% of patients. Proptosis was noted in 11 patients. The correct diagnosis was suspected in only 53% of patients at the time of first presentation to an ophthalmologist. The mean time from onset of symptoms to the time of correct diagnosis was 53 weeks (median 3 weeks). On direct questioning, eight patients reported a previous history of intermittent upper lid swelling and eight patients had a past history of sinusitis or frontal sinus trauma. Conclusions: We present a large series of patients with occult sinus disease presenting with orbital involvement. As patients with this potentially life-threatening condition are often misdiagnosed, we hope this paper draws the ophthalmologist's attention to key pearls in the history and examination to make a prompt diagnosis.