Case Report: A Rare Case of Silent Sinus Syndrome and Vertical Diplopia

Silent sinus syndrome is classically a maxillary sinus disease characterized by transient and variable vertical diplopia, hypoglobus, and enophthalmos. Uncommon presentations may exist, and although rare, it should be considered when diagnostic testing is inconsistent with more common etiologies of diplopia.

This study aimed to report an unusual presentation of silent sinus syndrome and review the thought process in diagnosing and managing this condition.

A 65-year-old white man presented to the eye clinic with left upper eyelid ptosis and intermittent vertical diplopia of 2-month onset. Clinical testing was variable, and initial differential diagnoses included a partial left pupil-sparing third nerve palsy involving the superior division, myasthenia gravis, and orbital disease. After extensive workup and review of his computed tomography images, the patient was diagnosed with severe chronic pansinusitis with an underlying condition known as silent sinus syndrome. He was referred to otorhinolaryngology for sinus decompression and oculoplastics for orbital reconstruction. While awaiting orbital reconstruction after decompression of multiple sinuses, he returned reporting a significant reduction in his diplopia.

Vertical diplopia is a common complaint in primary care optometry. It is important to delve into more rare etiologies when clinical, laboratory, and radiological studies do not support the more common diagnoses.