BACKGROUND: Mucoceles are polyp-like cysts located in the sinuses. Though they are benign space-occupying lesions, they can grow and extend into the orbit. Early detection is critical to minimize ophthalmic complications and permanent damage. Most patients with sinus mucoceles do not present with ocular symptoms. However, if ocular symptoms are present, the eye care provider may be the first health care provider to see these patients. Thus, it is imperative that eye care providers be aware of systemic disease with ophthalmic manifestations.
CASE REPORT(S). A 41 year-old white male presented with a complaint of an intermittent swollen right upper lid for three months. His medical history was unremarkable except for a previous sinus surgery, asthma, and allergies. His medications included Flovent, Claritin D, and Albuterol. Aided visual acuities were 20/20 in each eye. The external exam revealed a ptosis of the right superior lid and proptosis of the right eye. Motilities were restricted with the right eye in upgaze and left upgaze which resulted in vertical diplopia. Pupils, biomicroscopy, IOPs, DFE, and automated visual fields were unremarkable. Palpebral fissure width was 10 mm OD and 13 mm OS. Hertell exophthalmometry was 21 mm OD and 18 mm OS at 103. Asymmetry was found on globe repositioning. The right eye required more pressure to displace the globe. A CT scan of the orbits revealed a 2.8 cm x 2.3 cm x 2 cm mucocele in the right frontal sinus. The mucocele caused proptosis and inferolateral displacement of the globe. The mucocele was removed surgically by an otorhinolaryngologist.
CONCLUSIONS. Ptosis and proptosis are not a common presentation. It is important for eye care providers to recognize the significance and relation of these findings. A discussion of the case, the differential diagnoses, and the treatment options are included. Photodocumentation and the radiology study are also included.