[Painful ophthalmoplegia caused by chronic sphenoid sinusitis. Contribution of imaging]

Sphenoid sinusitis is a rare, often misdiagnosed, potentially lifethreatening infection. We report two cases of chronic sphenoid sinusitis presenting as painful ophthalmoplegia. We emphasize the difficulty of the diagnosis due to the deep-seated position of the cavity. The availability of CT and MRI should allow an early diagnosis. Attention has to be paid to the sphenoid sinus on every cranial image. In the chronic as well as in the acute form, the treatment is an emergency. Surgery procedures should be considered when antibiotics are inefficient. Sphenoid sinusitis must be considered in the diagnosis of painful ophthalmoplegia.