Ocular Manifestations of Diseases of the Paranasal Sinuses

Abstract

When making a survey of the eyes of patients who suffer from paranasal sinus diseases the ophthalmologist should study— 1. Color perception, central and peripheral; 2. Color acuity, central; 3. Visual acuity, central; 4. Campimetric measurements of the blind spot; 5. Peripheral field studies of form and colors; 6. Refractive errors; 7. Derangements of binocular vision; 8. Scotoma with the tangent screen; 9. Radiographs. Frontal Sinus Among the diseases of the frontal sinus presenting ocular manifestations are mucocele a distention by mucus, and empyema, of pus. At the upper and inner angle of the orbit a tumor can be palpated, accompanied by sensitiveness upon pressure over the frontal bones (Ewing's sign), tenderness at the attachment of the pulley of the superior oblique muscle, with headache and supraorbital pain. There are diplopia and epiphora, with an enlargement of the blind spot of Mariotte. Osteoma also causes a bulging of the upper and inner angle of the orbit, which is dense, painless, and of slow growth, being readily differentiated from mucocele and empyema by radiological studies. Ethmoids Knapp's retention cyst and mucocele of the ethmoid are synonymous. The lesion appears in the upper and inner angle of the orbit, above and behind the internal canthal ligament, displacing the eyeball downward and outward, and is differentiated from exostosis by an exploratory incision and the X-ray, preferably the latter. In ethmoiditis, one may find tumefaction of the inner third of the lid, diplopia, epiphora, faulty movements of the eyeball, and severe pain (ethmoidal syndrome). In posterior ethmoiditis of the sclerotic type, the pain is perhaps more severe (Meckel's ganglia syndrome), the threshold for color acuity is diminished, the blind spot of Mariette presents a concentric enlargement, the peripheral visual fields are contracted for form and color, central vision is diminished, and there is a central scotoma, differentiating the disease from sphenoiditis. The otolaryngologist generally makes the diagnosis, the radiologist concurring. Antrum When the antrum is the seat of the disease manifold symptoms are presented—edema of the lids, chemosis of the conjunctiva, edema of the optic nerve, distended blood vessels (veins), and affections of the lacrimal apparatus. The disease is generally diagnosed by the otolaryngologist and the radiologist. Foreign bodies in the paranasal sinuses may have entered through the orbit, or directly through the anterior wall; for instance, shot, shrapnel, missiles from small arms or machine guns, flying particles due to industrial traumatism or explosions, and possible accidental trauma during surgical operations. The diagnosis is essentially dependent upon the X-ray. Orbital abscess develops from pus escaping through the os planum into the orbital cavity.