| Identifier |
paranasal_sinuses_in_neuro_ophthalmology_lee |
| Title |
Paranasal Sinuses in Neuro-Ophthalmology |
| Creator |
Andrew G. Lee, MD; Andrew Chang |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (AC) Class of 2023, Baylor College of Medicine, Houston, Texas |
| Subject |
Sinuses; Sinus Disease; Silent Sinus Syndrome |
| Description |
Summary: • Para-nasal sinuses include the frontal, ethmoidal, sphenoid, and maxillary sinuses. • Ethmoid and sphenoid sinuses can be very close to the optic nerve and the orbital apex. o Frontal sinus disease can push the eye down, causing hypoglobus, leading to ophthalmoplegia. o Chronic maxillary sinus disease can also lead to hypoglobus. • Silent sinus syndrome is where the sinus gets smaller and smaller, but there is no sinusitis. o This leads to hypoglobus due to negative airway pressure, as well as vertical diplopia and ptosis. • Sphenoid and ethmoid sinusitis patients typically visit neuro-ophthalmology. o Mucus seals in posterior ethmoid sinuses won't be visible on the surface, but can affect the orbital apex or optic nerve. o These patients receive a scan to see if there's mass effect. o If the patient is losing their vision or has an RAPD, they need to be decompressed urgently to prevent permanent vision loss. • Mucus seals on the clinoid can press on the optic nerve. • Orbital apex has Onodi cells at the tip. • Acute retrobulbar optic neuropathy can be due to mucus seal, Aspergillosis infection, or Mucor infection in the immunocompromised. |
| Transcript |
So today we're going to be talking about the para-nasal sinuses, but not from the ENT perspective, from the neuro-ophth perspective. And so as you know you can have frontal sinus disease. You can have ethmoidal sinus disease, and then we have the maxillary sinus disease. So when patients have sinus disease it can be frontal, ethmoid, maxillary. And then in the axial view when we have the optic nerves, same problems can occur from the paranasal sinuses, sphenoid which is how they get access to the pituitary gland in transferring little surgery. And again the ethmoid air cells and the sphenoid are very close to the optic nerve and at the anterior clinoid and the optic canal, that's very very close to where the orbital apex is. So when we have problems of the para-nasal sinus, but in particularly ethmoid air cells or the sphenoid, it's very close to the optic nerve and the orbital apex. So those are the main anatomic features, and of course these drugs are very schematic. So when we have frontal sinus disease, if you have a frontal sinus mucus seal, it tends to push the eye down. And that's going to be hypoglobus, and those patients are going to have ophthalmoplegia because of the mass effect from the frontal sinus lesion. Normally that's not easy to see on the outside but the CAT scan is necessary to see the bone and also the mucus seal and the displacement of the eye. Maxillary sinus disease normally doesn't come down ophthalmology. However if you have chronic maxillary sinus disease, the eye can go down. That's hypoglobus again. And sometimes they don't have frank sinusitis, because the sinus is getting smaller and that's sometimes referred to as the silent sinus syndrome. So they have a smaller and smaller sinus because of negative airway pressure in the sinus, and the whole eye starts to sink down. So they'll have vertical diplopia, hypoglobus, the whole eye is down, and they might have ptosis. So the silent sinus syndrome and the frontal sinus mucosal are kind of the upstairs-downstairs versions of sinus disease affecting the orbit. So those normally go to the orbit doctors. The one that comes to me is the sphenoid sinusitis and the ethmoid sinusitis. So the neuro-ophth sinus disorders are from these posterior ethmoid air cells or the posterior sphenoid sinus. And the reason it's important to know that is because if you have a mucus seal in one of these posterior ethmoidal, it won't cause proptosis, it won't be visible on the surface. And so it's just going to go right into the orbital apex or compress the optic nerve. And so when we have a retro bulbar optic neuropathy, or an orbital apex syndrome ophthalmoplegia, and we see an opacity especially if it's a cystic capacity in the ethmoid air cell, we want to do a scan of the head and the orbit to look at that orbital apex and see if the lesion has got mass effect and compression. And in patients who are losing their vision, have an RAPD in an orbital apex syndrome, that's kind of an urgency. And so we need to decompress this, and if we don't decompress this, they might suffer permanent vision loss. And the last thing you need to know is sometimes patients have the mucus seal right at the level of the clinoid so that the canal is here, the ethmoid air cell and the clinoid. And so if you have that kind of mucus seal, it definitely can press on the optic nerve because it's right in the very small space the canal, or at the pointy part of the orbital apex. The ice cream cone has a very pointy tip, and that cell is the Onodi cell. So that cell is the posterior ethmoid cell, and it's very close to the posterior portion of the orbital apex. So in summary, if you're presented with an acute retrobulbar optic neuropathy, we should be looking at that ethmoid air cell and the posterior ethmoid or sphenoid. That could be a mucus seal, that could be fungus like aspergillosis, and in immunocompromised people that could be Mucor. So the adjacent sinus disease can come directly into the orbital apex and produce an acute retrobulbar optic neuropathy, or an acute orbital apex syndrome. The maxillary sinus and the frontal sinus disorders come to orbit, but sometimes they come to neuro-ophth, as hypoglobus and displaced eye and ophthalmoplegia. |
| Date |
2021-04 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6ps3sjg |
| Setname |
ehsl_novel_lee |
| ID |
1680614 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6ps3sjg |
