[Ocular symptoms and modern approaches to the treatment of silent sinus syndrome]

Silent sinus syndrome (SSS) is a rare condition characterized by spontaneous, progressive enophthalmos and hypophthalmos due to the collapse of the maxillary sinus, often accompanied by subclinical sinusitis.

This study evaluates the clinical outcomes of treating patients with silent sinus syndrome (SSS) using a two-stage treatment approach.

The study included 22 patients (22 eyes) with SSS who were examined at the Krasnov Research Institute of Eye Diseases between 2011 and 2023. Patients presented with complaints of enophthalmos, hypophthalmos, binocular diplopia, and decreased vision. The mean age was 36 [26; 48] years, male-to-female ratio was 6:16. All patients underwent Hertel exophthalmometry, measurement of palpebral fissure, assessment of binocular status, as well as multislice computed tomography (MSCT) of the paranasal sinuses at admission, 3 months after the first stage, and during the follow-up after the second stage of treatment. The first stage involved functional endoscopic sinus surgery (FESS), and the second stage involved correction of the eyeball position.

The follow-up period lasted a mean of 28 [6; 120] months. After FESS, 12 patients (12 eyes) were satisfied with the cosmetic outcome, while 10 patients (10 eyes) decided to apply for a second stage of treatment. Two patients underwent nonsurgical correction of enophthalmos with intraorbital injections, and eight underwent orbital reconstruction with implant placement. Treatment outcomes showed a significant reduction in mean value of enophthalmos (from 3.5 mm to 0.5 mm), a decrease in upper eyelid excursion compared to the contralateral side (Δ changed from 4 to 1 mm), reduction of hypophthalmos (from 2 mm to 0 mm), improvements in corneal condition and ocular motility, and regression of diplopia. No complications were registered.

Diagnosis and treatment of SSS require a multidisciplinary approach. The two-stage treatment strategy for SSS provides good functional and aesthetic outcomes.