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
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
Sinogenic Ophthalmic Manifestations Anatomic disturbance Mild functional disturbance Visual impairment Disease related Manifestation
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.
AFS Ophthalmic Manifestation Varies from proptosis
AFS Ophthalmic Manifestation To visual loss
Mucocele Ophthalmic Manifestation Varies from Proptosis, Tearing, etc
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
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)
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%) 0 1 9 5 15 0 1-2 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%) 0 3 1 2 0 6 3 4 3 5 0 8 6 11 1 0 0 5 1-2 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.
Results The Sinogenic Ophthalmic Manifestation Causes: Allergic Fungal Sinusitis (50%) Chronic Rhinosinusitis (36%) Acute Sinusitis (10%) Mucocele in (4%)
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
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.
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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