Ophthalmic manifestations of fronto-ethmoidal mucocoeles: a report of five cases

Fronto-ethmoidal mucocoele is rare and will cause visual impairment and blindness when management is belated. In order to improve the awareness of its ophthalmic manifestations and problems associated with its management we retrospectively analyzed clinical, radiological and histological features in five illustrative cases. They all presented with unilateral supra-orbital swellings and proptosis, antedated by head injury in two cases. Other ophthalmic manifestations included eye lid swelling, progressive visual loss, unilateral ptosis, exotropia and diplopia. Only two patients had nasal symptoms. In all cases, x-rays of the paranasal sinuses revealed radiolucent frontal sinuses with eroded anterior walls, floors and midline septa. Brain scan in one case demonstrated opacification and enlargement of the corresponding sinus. Fronto-ethmoidectomy in four cases confirmed erosion of sinus' walls and floors and in one case of the contiguous supra-orbital ridge in addition to colored fluid aspirates. In all cases, the curetted sinus lining comprised of chronic inflammatory tissue. Surgical intervention was followed by prompt postoperative resolution of ophthalmic manifestations. A high level of suspicion is essential for early diagnosis and treatment of fronto-ethmoidal mucocoeles and will assist in preventing irreversible visual loss.