Analysis of cases of sinus-derived optic neuropathy

Purpose Sinus-derived optic neuropathy(ON) involves several medical subjects. It usually shows ophthalmological symptoms and signs, sometimes including neurological manifestation, and its diagnosis and treatment can not be solely conducted by ophthalmologist. We hope doctors in these areas, including eye, ENT, neurology, imaging, vascular imaging, can seek to exploit new methods to improve our diagnosis and treatment for the patients.
Methods We retrospectively analyzed 5 cases of sinus-derived ON with detailed data which were mis- or missed- diagnosed. Sinus-derived ON cases can be divided into for types: inflammatory, traumatic, compressive and vasculature-diastrophic. Clinical manifestation includes: decreased visual acuity; pulsed or non-pulsed proptosis; constricted or non-constricted abnormal eye movement; ptosis; dizzy and tinnitus, etc. Five patients all showed decreased visual acuity, abnormal eye movement and dizzy. Furthermore, 1 patient showed ptosis; 3 patients(4 eyes) showed proptosis; 2 patients showed tinnitus. In theses cases, 1 case was diagnosed as orbital cellulitis with internal carotid cavernous fistula(CCF), 1 orbital inflammatory pseudo-tumor with 2 eyes, 1 orbital fracture, 1 CCF with orbital fracture and 1 CCF without orbital fracture. Diagnostic methods: 2 cases were diagnosed by orbital auscultation showing vascular bruit; Vascular imaging was performed to 2 CCF cases and cavernous embolism. CT scanning showed 2 cases of orbital fracture with ethmoidal hyphemia and 1 case of orbital inflammation and sinusitis. Treatments: 2 cases were treated by steroids; 2 by interventional therapy; 1 by orbital reconstruction surgery under endoscope.
Results All 5 patients were effectively improved: all alive and with useful visual acuity, and all the clinical symptoms and signs disappeared.
Conclusions Sinus-derived ON varies with signs and is comprehensive. It is inclined to be mis- or missed diagnosed with first visit. Especially, orbital fracture with CCF is rarely encountered and is mostly likely to be mis-diagnosed. Local orbital auscultation can be easily performed and should be defined as routine examination. High-resolution CT and vascular radiography can establish diagnosis and provide effective treat strategy. Sinus-endoscope surgery, with blood-pressure controlling technique, has been used into rhino-orbital related field. It contains wonderful illumination and magnification devices, and can produce mini-wound, less complications, faster rehabilitation, less scar and anatomic and functional recovery. So, sinus-endoscope surgery in rhino-orbital related field is worth to be extended. But, doctors should be trained strictly before performing this complicated surgery on patients.