Clinical Study of Paranasal Sinus Cyst with Orbital Manifestations

Paranasal sinus cyst may cause orbital manifestations such as visual disturbance, diplopia, and oculomotor disturbance. We treated 15 cases—11 men and 4 women—of paranasal cyst with orbital symptoms from January 2005 to December 2009. We assessed the chief orbital complaint, lesion site, case history, history of sinus surgery, first diagnostic visit, and prognosis. Four of the 15 with visual disturbance were analyzed further. Subjects were 31 to 71 years old (mean; 61.3 years). Of the 15, 11 (73.3%) had postoperative cysts and 4 (26.7%) had idiopathic cyst. Among paranasal sinus cysts, 4 were maxillary, 3 each anterior ethmoid and frontoethmoid, 2 sphenoethmoid, 1 each posterior ethmoid, frontal, and sphenoid sinuses. Of the 15, 12 had first seen ophthalmologists and 2 an internist. Time from orbital symptom onset to the first diagnostic visit averaged 5.9 (0 to 44) days. Chief complaints were visual disturbance in 4, diplopia in 7, and oculomotor disturbance in 4. All underwent endoscopic sinus surgery, after which orbital symptoms disappeared in most. Visual acuity returned to expected levels after surgery in the 4 with visual disturbance. Of orbital manifestations, visual disturbance was considered the most serious clinical feature because vision loss may become permanent without immediate surgical exploration. We consider specifically treating the involved sinuses soon after diagnosis to be of primary concern.