Introduction. Ophthalmic manifestations can result from a myriad of Non Sinogenic and Sinogenic Disease :

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1 Ophthalmic Manifestations of Paranasal Sinus Disease; A Clinical Grading System Surayie Al Dousary, MD Associate Professor Director Rhinology Research Chair & Fatma Al Anazy, MD Associate Professor Rhinology Research Chair, Saudi Arabia Rhinology Research Chair, Saudi Arabia sdousary@csc.net.sa

2 Introduction Ophthalmic manifestations can result from a myriad of Non Sinogenic and Sinogenic Disease : Acute sinus infection Secondary orbital inflammation Chronic sinus inflammation Resulting in expansion and erosion of the surrounding structure Sinus Mucoceles Orbital Extension Local Immunological reactions Orbital involvement

3 Sinogenic Ophthalmic Manifestations Anatomic disturbance Mild functional disturbance Visual impairment Disease related Manifestation

4 Classification of Sinusitis Orbital Complications In 1937, Hubert published a classification of sinusitis complications, which included palpebral, orbital, and intracranial diseases. In 1948, Smith and Spencer used the Hubert classification to stage orbital complications In 1970 Chandler grouped his patients under five heads: Group I Preseptal cellulites, Group II Orbital cellulitis, Group III Subperiosteal abscess,group IV Orbital abscess and Group V Cavernous sinus thrombosis In 1994, Bent and Kuhn described what probably are the most widely accepted criteria for AFS diagnosis.

5 AFS Ophthalmic Manifestation Varies from proptosis

6 AFS Ophthalmic Manifestation To visual loss

7 Mucocele Ophthalmic Manifestation Varies from Proptosis, Tearing, etc

8 Material and Methods Forty two patients with Paranasal sinus diseases (Acute and Chronic) present with ophthalmic manifestation Rhinology Research Chair,, Saudi Arabia January 2008 and December 2010 Exclusion Criteria: Tumors Non Sinonasal Orbital Pathology Clinical Assessment ( ENT & Ophthalmology Consultants) Computed Tomography (CT), and MRI

9 Management All Patients underwent Functional Endoscopic Sinus Surgery CT Guided FESS in cases with extensive disease The urgency of intervention proportional to the severity of the disease Medical Treatment Antimicrobial (Infection) Systemic Steroid (AFS)

10 Results Grade Presentation Number of Patient s Acute sinusitis Mucoce l AFS CRS Proptosis Orbit Infectio n Visual Impairm et Follow Up I Anatomical disturbance Proptosis 15(36%) y II Functional involvement III Orbital infection IV Visual impairment Epiphoria, Diplopia, Ophthalmoplegia, Ptosis Orbital cellulitis, Pre septal-cellulitis, Orbital abscess, Subpereostial abscess, Cavernous sinus thrombosis Visual Impairment, Blindness 11(26%) 11(26%) 5(12%) y 3M -2 y 1M-2 y 20 male and 22 female, Their age ranged from 8 to 65 year with a mean age of 30 year, 12 child.

11 Results The Sinogenic Ophthalmic Manifestation Causes: Allergic Fungal Sinusitis (50%) Chronic Rhinosinusitis (36%) Acute Sinusitis (10%) Mucocele in (4%)

12 Conclusion The Proposed Clinical Grading System grade I grade II grade III grade IV Disturbance of ophthalmic Anatomy Mild Disturbance of Ophthalmic Function Orbital Infection Visual Impairment

13 Conclusion This is an easy to apply Clinical grading system that doesn t require Imaging Encompass Sinogenic Acute orbital infection and chronic pathology causing orbital manifestation. Help to classify the cases and measure the outcome. The main cause of orbital complications is chronic Paranasal sinus disease in (74 %) of the cases. Visual Impairment group (Grade IV) has unfavorable outcome.

14 References 1. Hubert L. Orbital infections due to nasal sinusitis. N Y State J Med 1937; 37: Oxford LE, McClay J. Complications of acute sinusitis in children. Otolaryngol Head Neck Surg 2005; 133: Davis JP, Stearns MP. Orbital complications of sinusitis: avoid delays in diagnosis. Postgrad Med J 1994; 70: Coop CA, England RW. Allergic fungal sinusitis presenting with proptosis and diplopia: A review of ophthalmologic complications and treatment. Allergy Asthma Proc 2006; 27: Klapper SR, Patrinely JR. Orbital involvement in allergic fungal sinusitis. Ophthal Plast Reconstr Surg 2001; 17: Geren BN, Brown HH, Hearnsberger HG 3rd, Westfall CT. Allergic fungal sinusitis with unilateral eye involvement. Arch Ophthalmol 2004; 122: Lai PC, Liao SL, Jou JR, Hou PK. Transcaruncular approach for the management of frontoethmoid mucoceles. Br J Ophthalmol 2003; 87: Shah A, Meyer, Parnes S. Management of frontoethmoidal mucoceles with orbital extension: is primary orbital reconstruction necessary? Ophthal Plast Reconstr Surg 2007; 23: Gupta AK, Bansal S, Gupta A, Mathur N. Visual loss in the setting of allergic fungal sinusitis: pathophysiology and outcome. J Laryngol Otol 2007; 121: Smith AT, Spencer JT. Orbital complications resulting from lesions of the sinuses. Ann Otol Rhinol Laryngol 1948; 57: Mortimore S, Wormald PJ. The Groote Schuur hospital classification of the orbital complications of sinusitis J Laryngol Otol 1997; 111: Moloney JR, Badham NJ, McRae A. The acute orbit. Preseptal (periorbital) cellulitis, subperiosteal abscess and orbital cellulitis due to sinusitis J Laryngol Otol Suppl 1987; 12: Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications of acute sinusitis. Laryngoscope 1970; 80: Skedros DG, Haddad J Jr, Bluestone CD, Curtin HD. Subperiosteal orbital abscess in children: diagnosis, microbiology, and management. Laryngoscope 1993; 103(1 Pt 1): Deutsch E, Eilon A, Hevron I, Hurvitz H, Blinder G. Functional endoscopic sinus surgery of orbital subperiosteal abscess in children. Int J Pediatr Otorhinolaryngol 1996; 34: Reddy SC, Sharma HS, Mazidah AS, Darnal HK, Mahayidin M. Orbital abscess due to acute ethmoiditis in a neonate. Int J Pediatr Otorhinolaryngol 1999; 49: Gurucharri MJ, Lazar RH, Younis RT. Current management and treatment of complications of sinusitis in children. Ear Nose Throat J 1991; 70: Swift AC, Charlton G. Sinusitis and the acute orbit in children. J Laryngol Otol 1990; 104: Goldberg F, Berne AS, Oski FA. Differentiation of orbital cellulitis from preseptal cellulitis by computed tomography. Pediatrics 1978; 62: Schramm VL Jr, Curtin HD, Kennerdell JS. Evaluation of orbital cellulitis and results of treatment. Laryngoscope 1982; 92(7 Pt 1): Ognibene RZ, Voegels RL, Bensadon RL, Butugan O. Complications of sinusitis. Rhinology 1994; 8:

15 Rhinology Research Chair 2011 Conference and Workshops Nov 21-24,2011 Upper Airway Allergy Update and Workshop. Conference on Fungal Sinusitis Functional Endoscopic Sinus Surgery Course. Thank You Riyadh Saudi Arabia