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J. A. Liss, S. T. Stefko, J. Y. Yu; Bilateral Silent Sinus Syndrome Presenting With a Chronic Corneal Ulcer: A Case Report. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4816.
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The silent sinus syndrome is a rare but well-documented clinical entity. It is characterized by spontaneous and progressive enophthalmos and hypoglobus due to collapse of the maxillary sinus and orbital floor, in the setting of subclinical maxillary sinusitis and chronic maxillary hypoventilation. We present a case of bilateral silent sinus syndrome presenting with a chronic corneal ulcer.
The clinical history and examination of a single patient are presented.
A 56-year-old male with a remote history of endonasal lymphoma treated with sinus surgery, radiation and chemotherapy was referred for evaluation for possible tarsorrhaphy to treat a non-healing corneal ulcer. The patient was found to have profound bilateral temporal and periorbital fat wasting, deep superior sulcus defects on the left more than the right, and left-sided relative enophthalmos of 3mm. He had a corneal ulcer on the left with mildly reduced corneal sensation. These findings raised suspicion for recurrence of his lymphoma causing lipodystrophy and enophthalmos, and an orbital CT scan and medical workup were obtained. The CT scan showed, bilaterally, the classic findings of silent sinus syndrome including enophthalmos, hypoglobus, downward collapse of the orbital floors, inward bowing of the anterior, medial and lateral walls of the maxillary sinuses, obstruction of the maxillary outflow tracts and chronic sinusitis. There is a large air bubble between the globe and the eyelid on each side.
This is, to our knowledge, the first reported case of bilateral silent sinus syndrome. It is also unique in that the presenting sign of silent sinus syndrome in this case was a chronic corneal ulcer related to enophthalmos. The large air bubble between the globe and the eyelid due to enophthalmos may play a role in causing the keratopathy.
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