Laughter-induced transient vision loss in a patient with silent sinus syndrome

Silent sinus syndrome is a rare disease when the maxillary osteomeatal complex is blocked, resulting in negative maxillary sinus pressure and eventual atelectasis of the maxillary antrum.

Poster 146 Laughter-induced transient vision loss in a patient with silent sinus syndrome Sara Reggie1, Krishna Kalyam2, Sophia Chung1, John Holds3 Saint Louis University Eye Institute, St. Louis, Missouri, USA, 2Washington Unversity, St. Louis, Missouri, USA, 3Saint Louis University Eye Institute Ophthalmic Plastic and Cosmetic Surgery, Inc., St. Louis, Missouri, USA 1 Introduction: Silent sinus syndrome is a rare disease when the maxillary osteomeatal complex is blocked, resulting in negative maxillary sinus pressure and eventual atelectasis of the maxillary antrum. Methods: Case summary Results: We present a unique case report of a 32-year-old otherwise healthy female patient with untreated silent sinus syndrome who experienced transient ipsilateral monocular vision loss during intense laughter. The patient's transient vision loss resolved after maxillary sinus decompression. Conclusions: Silent sinus syndrome is the result of blockage of the maxillary osteomeatal complex, resulting in negative maxillary sinus pressure, with atelectasis and eventual collapse of the maxillary antrum. The authors hypothesize that this patient's transient blindness was likely due to compromised retinal blood flow from both the internal carotid artery and its external carotid artery collateral branches. Future cases of this phenomenon would benefit from angiographic studies to better understand its pathophysiology. References: Soparkar, C.N., et al., The silent sinus syndrome. A cause of spontaneous enophthalmos. Ophthalmology, 1994. 101(4): p. 772-8. Numa, W.A., et al., Silent sinus syndrome: a case presentation and comprehensive review of all 84 reported cases. Ann Otol Rhinol Laryngol, 2005. 114(9): p. 688-94. Cox, S.V., A.C. Eisenhauer, and K. Hreib, "Seinfeld syncope". Cathet Cardiovasc Diagn, 1997. 42(2): p. 242. Macchi, C. and C. Catini, The anatomy and clinical significance of the collateral circulation between the internal and external carotid arteries through the ophthalmic artery. Ital J Anat Embryol, 1993. 98(1): p. 23-9. Keywords: Orbit/ocular pathology, Vascular disorders, Orbit Financial Disclosures: The authors had no disclosures. Grant Support: None 198 | North American Neuro-Ophthalmology Society