Silent sinus syndrome: two cases presenting with sudden-onset vertical diplopia

Abstract

Aim: To report the clinical signs of silent sinus syndrome and raise orthoptic awareness of this condition, which may present with vertical diplopia. Method: With informed patient consent, we describe 2 cases of silent sinus syndrome seen at the orthoptic department within a 2 year period. They presented with sudden-onset vertical diplopia. Orthoptic find­ings with Hess charts are documented, together with a photograph and CT image for one case. Investiga­tion and management arc discussed, and the litera­ture on silent sinus syndrome is reviewed. Results: Both patients were male, aged 44 and 54 years respectively, were of good general health, and had no history of orbital trauma or disease. A small vertical deviation was found in primary position, with slight limitation of one eye on upgaze and slight hypoglobus. Following CT scanning the diagnosis in each case was silent sinus syndrome. Both patients underwent maxillary sinus washout, and one patient had an orbital floor implant. Diplopia resolved post-operatively in both eases. Conclusion: Silent sinus syndrome is an uncommon condition associated with asymptomatic maxillary sinus disease, and should be considered in the differential diagnosis of vertical diplopia.